ORAL ANSWERS TO QUESTIONS

CULTURE, MEDIA AND SPORT

The Secretary of State for Culture Olympics, Media and Sport was asked—

Gambling

Kelvin Hopkins: Whether she plans to reintroduce the gambling prevalence survey; and if she will make a statement.

Hugh Robertson: I welcome the recent announcement by the Responsible Gambling Trust of a major research project into gaming machines. A new approach to collecting data on gambling prevalence and trends in problem gambling has been adopted by the Gambling Commission; this will be cost-effective and has the potential to provide more frequent information than the old gambling prevalence survey.

Kelvin Hopkins: Compulsive gambling ruins lives and destroys families. The most addictive form of gambling is on fixed-odds betting terminals, or gambling machines, which are described as the crack cocaine of gambling. Are the Government seriously concerned about gambling addiction, and what are they going to do to address the problem?

Hugh Robertson: Yes, the Government are seriously concerned about problem gambling. This is one of those quite tricky areas where common sense suggests that it is a major problem but there is a lack of evidence to back that up. I very much hope that the major research project that is being undertaken will give us the necessary evidence and, absolutely, once the problem is proved to exist, the Government will act.

John Penrose: Does the Minister agree that there is currently not much evidence to prove that fixed-odds betting terminals are the most addictive form of gambling? Although I applaud his concern for the problems caused by problem gambling, will he reassure the House that he will proceed only on the basis of firm evidence when that is available?

Hugh Robertson: Absolutely, in accordance with the answer that I gave earlier. It is recognised that there is an issue in this area, but there is a lack of authoritative evidence to back that up, and that is precisely what we are looking for.

Harriet Harman: I completely agree with the point made by my hon. Friend the Member for Luton North (Kelvin Hopkins). Concern is shared across the House, so we want to see
	the Government doing something about it. We all know—there is bags of evidence—that gambling is blighting people’s lives, and blighting our high streets too, given the prevalence of betting shops. We need only look down our own high streets; we do not need a research project to see what is going on. The Government say that they want localism and that they are in favour of local people having a say, so will they change the planning laws so that local people have the power to prevent any more betting shops from opening up on their high streets if they do not want them?

Hugh Robertson: The answer to the right hon. and learned Lady is yes, if the evidence supports that, but no Government of any colour have ever produced a policy without the backing of real evidence to support it. [ Interruption. ] The hon. Member for Slough (Fiona Mactaggart) was of course a Minister in the previous Government, so if she wishes to laugh that probably tells us rather a lot. She might wish she had kept her mouth shut. As I said, once we have the evidence we will proceed.

Public Libraries

Bob Blackman: If she will take steps to encourage use of public libraries and to discourage local authorities from closing or reducing the usage of such libraries.

Edward Vaizey: We are doing a lot to support libraries. We have given Arts Council England responsibility for libraries and it has set up a £6 million fund to support culture in libraries. We have just appointed a specialist adviser. We have regular communications with councils. We have announced our e-learning review. Only at the end of last year we published our comparative reports on library performance.

Bob Blackman: Libraries provide a centre for deprived children to be able to study when there are no facilities at home. I highlight a case where Brent council closed six of its libraries last year. Since then, library visitor numbers have fallen by 130,000. The council attempted to save nearly £1 million by closing the branch libraries, but it has had to mothball them, which has cost it £500,000. Equally, £120,000 has been spent on legal fees. At the same time, it is negotiating—

Mr Speaker: Order. The hon. Gentleman must resume his seat. The question is simply too long, and it is not clear what it is.

Bob Blackman: rose—

Mr Speaker: No, the hon. Gentleman has taken far too long, and he has enough experience that he ought to be able to be more succinct. Let us have a brief response from the Front Bench.

Edward Vaizey: Briefly, libraries are run and paid for by local authorities. I hear what my hon. Friend says. Perhaps it is best to point to good examples of Tory councils, such as Hammersmith and Fulham and Hillingdon, which have kept their libraries open and are reducing or freezing their council tax at the same time.

Lyn Brown: I wonder whether the Minister has had time to reflect on passing the responsibilities for library development to the Arts Council and whether he now regrets not using the money instead to create a perfectly formed, small library development agency.

Edward Vaizey: In times of economic austerity one has to be careful with public funds, but in any event I think it is long overdue for the Arts Council to have responsibility for libraries, in order to join up responsibility for local libraries with local culture.

John Pugh: In my constituency, Sefton is proposing to close all the branch libraries, radically reducing access. Does the Minister think that that is the only or best way to deal with the budgetary squeeze and will he look into that particular case?

Edward Vaizey: We always keep an eye on proposals by local authorities to reorganise their library services and we will certainly keep an eye on those proposals.

Football Stadiums

John Mann: What recent assessment she has made of safety within football stadiums.

Hugh Robertson: Current policy on safety at football stadiums in England and Wales has developed as a result of the Taylor report, following the Hillsborough tragedy. Thankfully, there have been no major incidents resulting from safety failures at those stadiums since then.

John Mann: Unfortunately, safety is configured on what has happened previously, not on what could happen in future. Is it the case that all football stadiums in this country have been tested for mass evacuation on nothing other than a computer model that presumes perfect behaviour by all in the stadium?

Hugh Robertson: Guidance is issued by the Sports Grounds Safety Authority, which produces “The Guide to Safety at Sports Grounds”, commonly known as the green guide. That includes guidance on the importance of inspections and testing of contingency plans, including full evacuation procedures. The guidance is there. If that is not happening, that should not be the case.

John Leech: Given the impossible task that clubs face to keep some fans seated at football matches, is it not time to carry out an assessment of whether it would in fact be safer for grounds to introduce safe standing areas rather than people continuing to stand in areas that are not designed for standing?

Hugh Robertson: The requirement to have all-seater stadiums was, as the hon. Gentleman will know, one of the recommendations of the Taylor report. I undertook to look at this area when the coalition came to power in 2010. All the advice I received from the football authorities, the police and everybody involved in public safety was
	to make no change. For any Minister to make a change ignoring the prevailing safety advice would be extremely unwise.

Olympic Legacy

Charlotte Leslie: What progress her Department has made in securing an Olympic legacy for the UK.

Maria Miller: We are already seeing the positive impact of the Olympics and Paralympics across our legacy programme, clear benefits to our international reputation, shifts in the perception of disability, both at home and abroad, and, importantly, more people, particularly women, playing sport. Investment in grass-roots and elite sport is designed to maintain that important momentum.

Charlotte Leslie: I thank the Secretary of State and commend the Government’s work. The sad truth is that, in difficult economic times, with council bills rising, some community clubs, particularly boxing clubs, which are proven to do so much good work in the community, are struggling to stay open. Will she confirm that she will continue to support those clubs so that they can maintain our legacy and, indeed, furnish us with future Olympians?

Maria Miller: Grass-roots clubs such as those mentioned by my hon. Friend are vital if even more people are to participate in sport. That is why we have given great priority to investing in local sports venues. This Government have also introduced the Places People Play programme, which is giving £150 million to upgrade 1,000 local sports venues. That is just the sort of action that I am sure my hon. Friend would see as positive.

Barry Sheerman: Will the Minister pledge this morning to analyse how the legacy cascades to all the regions of Britain? She will know of the threatened imminent closure of the Sheffield stadium, which was built for the student games in a past era. The fact is that regions such as Yorkshire are not getting the benefits of the legacy of the Olympics seen in places such as the south of England.

Maria Miller: The hon. Gentleman makes an important point. Although the games were called London 2012, they were Olympic and Paralympic games for the whole country and it is important that those benefits come through at a regional level. I believe that we will enable that through all our programmes, including Places People Play which I have mentioned, as well as many others. We will continue to look at regional benefits.

Duncan Hames: Team GB achieved great success on the water at the Olympics, not just in rowing, but through Bradford-on-Avon’s Olympic gold medallist Ed McKeever in the kayaking. Is the Secretary of State satisfied that sculler schools and canoeing clubs have enough access to rivers, and will she consider having discussions with the Department for Environment, Food and Rural Affairs about a possible right to roam?

Maria Miller: The hon. Gentleman is right that it is important that people who are involved in those water sports have access to water. We have to balance that with the requirements of other sporting groups, such as anglers, but we will continue to monitor the access to important water facilities because I, like other right hon. and hon. Members, want to see further success at the Rio games.

Clive Efford: An Olympic legacy must begin in our schools, yet this Government have cut school sport partnerships, the school sport survey and outdoor play spaces in our schools, and abolished minimum targets for school sport. We are still waiting for their announcement on school sport, which we all expected before Christmas. It is no wonder that less time is being spent doing sport in our schools. When will her Department get to grips with the Secretary of State for Education and lay the foundations that we need for a true sporting legacy?

Maria Miller: The hon. Gentleman is right to focus on the importance of sport in the earliest years. I am sure that he will join me in applauding what the Government have done through the school games and the £1 billion youth strategy, and the role of people such as Ellie Simmonds and Jess Ennis at the Olympic games in inspiring the next generation. Perhaps he should focus on that positive record and applaud the work of the Government.

Broadband

John Glen: What progress her Department has made in rolling out rural broadband.

Edward Vaizey: We are making very good progress. Nine local projects have agreed contracts, and I switched on the first street cabinet supported by the rural broadband programme at Ainderby Steeple in North Yorkshire on 13 December.

John Glen: I thank the Minister for that answer. It is excellent news that Wiltshire council is now able to roll out superfast broadband. However, the Minister has to agree that a small percentage of households—typically 2% to 3%—will not be affected by the roll-out. What does he have to say about the small number of rural communities that will not take advantage of the roll-out of broadband across the county and across England?

Edward Vaizey: Our ambition is to get 90% of premises connected to superfast broadband, but to get all premises connected to broadband speeds of 2 megabits per second. There should be a broadband service for almost all households and that will be technologically neutral, so it should be the right technology solution for them.

Stephen Timms: The Government were wrong to drop the previous Government’s commitment to deliver a universal broadband service of 2 megabits per second by last year. Has the Minister seen this week’s report by Policy Exchange, which re-emphasises
	the importance of finally delivering the universal availability of broadband of 2 megabits per second, particularly in rural areas, where businesses are so dependent on it?

Edward Vaizey: The right hon. Gentleman is a distinguished former telecoms Minister, so I take what he says very seriously. I was at the launch of the Policy Exchange pamphlet, but I do not agree with him. I think that it is right that we have a superfast broadband commitment of 90% by 2015, which is realistic and achievable.

Roger Gale: A considerable amount of money is being released from the sale of spectrum for reinvestment in broadband. Superfast broadband is important to business, but surely rural areas should also benefit. Is 2 megabits really too much to ask?

Edward Vaizey: No, 2 megabits is not too much to ask, which is why we will deliver 2 megabits to the last 10%.

Helen Goodman: As my right hon. Friend the Member for East Ham (Stephen Timms) said, Policy Exchange produced an important report yesterday, which I thought the Minister had welcomed. It said that the Government should stop
	“pursuing speed as a proxy for progress”
	and focus
	“explicitly on economic and social outcomes”.
	The report pointed out that 16 million people lack basic IT skills and that that is one of the major reasons that people give for not getting online. What specific action will the Minister take to help those people?

Edward Vaizey: I hear what the hon. Lady says. It is good to hear her endorsing the work of Policy Exchange, a distinguished centre-right think-tank. I hope that she will continue to support its policy proposals. As I said at the launch of the Policy Exchange pamphlet, Go On UK is doing extraordinarily good work to encourage people to go online. Along with all the councils that are procuring superfast broadband, we have a strategy to encourage people to take up broadband.

Sport (Disabled People)

Stuart Andrew: What steps she is taking to improve access to sport for disabled people.

Maria Miller: For the first time, access to sport for disabled people is at the heart of Sport England’s £1 billion youth and community sports strategy. UK Sport recently announced more than £70 million of funding for our elite Paralympic athletes, which is 43% more than the investment they received for London 2012. Last month alone, we invested more than £10 million in 44 community sports projects for people with disabilities.

Stuart Andrew: Voluntary sports groups in my constituency have worked for a number of years with local special schools to provide coaching for disabled children. They are now working with sports colleges, developers and councillors to create a new sports park to increase and improve access for all. Does my right
	hon. Friend agree that that is excellent work and will she commend those groups? Can her Department help us to make the dream a reality?

Maria Miller: My hon. Friend is absolutely right. Such innovative working can make a real difference for disabled children, and help disabled adults get access to sporting facilities. I want the Department to do everything it can to support such work, and I point my hon. Friend towards the funding that the Government have already made available for such community sport projects, which I hope will help him.

Nicholas Dakin: It was great to see so many Paralympians recognised in the new year’s honours list, but does the Secretary of State share my disappointment that disabled sportsmen and women appear to have to do so much more than others to achieve similar recognition?

Maria Miller: I hope the hon. Gentleman will recognise that this time around there has been much more recognition for our Paralympic athletes, and rightly so. We must continue to strive to do even better, but I hope he will agree with me that the sort of investment that the Government are putting into Paralympic sports will ensure that Paralympic athletes have better support in the future to achieve their very best.

Club Sport

Graham Stuart: What steps she is taking to ensure that participants in club-level sport have access to suitable and sustainable facilities.

Hugh Robertson: Sport England’s Places People Play programme has already helped to upgrade and improve 732 local sports facilities as part of the London 2012 sports legacy, including three projects in my hon. Friend’s constituency. In addition, it has invested more than £20 million in 12 new large scale multi-sport facilities.

Graham Stuart: Does the Minister agree that local councillors have a big part to play, and will he join me in congratulating Councillor David Elvidge and other Conservative councillors in Beverley who are working hard to find additional football pitch availability in that area? Mike Bryan and other councillors in the Hedon area are supporting Eastside Community Sports, and many clubs are doing much good work, making a real difference and building on the Olympic legacy.

Hugh Robertson: I absolutely agree, and the two important points are, first, that local councils prioritise that issue—we all know that the economic climate is tough, but they have had a fantastic launch pad through London 2012 and it is now up to them to make it work. Secondly, councils will need the support of local volunteers. I am delighted to add my congratulations to the people mentioned by my hon. Friend.

Luciana Berger: I listened closely to what the Minister said about local authorities, but in Liverpool, which has seen a £252 cut per head, it is challenging for the local authority to
	make such decisions to prioritise sport and to have that investment available. What will the Government do to help councils that have seen such drastic cuts to ensure that sporting facilities, particularly local clubs, are supported?

Hugh Robertson: Nobody would pretend that this issue is easy and we all know the economic conditions. As I said, London 2012 has given sport in this country a fantastic launch pad, and a city such a Liverpool—which the hon. Lady represents—is synonymous with sport. My advice would be that the most successful projects I have seen are a combination of local authority funding, private funding and grants from Sport England. If the hon. Lady has projects that she wishes to promote, she should look to Sport England and the Places People Play initiative and see what she can do. I wish her every good fortune in doing that.

Leveson Inquiry

Simon Hughes: When the Government plan to announce what further steps they will take in response to the report of the Leveson inquiry.

Maria Miller: Lord Justice Leveson’s report, which was welcomed by the Government, set out the need for independent self-regulation of the press. I believe the press will be setting out their new self-regulatory approach in line with Leveson later today. As all parties agree, the report did not provide a fully formed blueprint but rather an outline that requires further work and consideration. The Government are working on a cross-party basis and with interested groups, and I believe we are making progress.

Simon Hughes: I thank the Secretary of State for that positive reply. May I encourage her to ensure that the cross-party talks reach a conclusion before the end of this Session of Parliament, so that if we need to legislate not just on the difficult issue of statutory underpinning of press regulation but on clearing up the relationship between the police and the press, we can do so in the next Session?

Maria Miller: My right hon. Friend is absolutely right. Making progress and ensuring we have momentum is vital for two reasons. First, we need to ensure that we do not see the unacceptable treatment of victims again in future. Secondly, all who have watched this lengthy process want it to come to a speedy conclusion. I can give him a clear undertaking today that that is exactly where we are.

Mark Durkan: Hon. Members have heard the clichés about no more drinking at the last-chance saloon for the press, but can the Secretary of State assure us that the Government’s engagement with the press on this matter has not simply been a lock-in at the Long Grass Arms, where the Government’s order is, “Whatever you’re having yourself”?

Maria Miller: The Leveson report clearly gives us a framework to ensure we make progress on the important issues that will make a difference to press regulation, and to ensure that we do not have the problems we have had and the same treatment of victims in future. It is
	not possible for us to do anything other than make progress if we are to implement Leveson, and that is what we are looking to do.

Boxing

Paul Flynn: What her policy is on promoting young people’s participation in boxing.

Hugh Robertson: In the recent UK Sport and Sport England funding announcement, our elite boxers receive £13.8 million to help them prepare for Rio 2016, a 44% increase on the amount available at the last Olympics, which reflects their success. Under the whole sport plan, the Amateur Boxing Association of England will receive £5.8 million to drive up participation, an increase of 22% on the previous funding period. Boxing is a part of the school games, and schools are free to provide their pupils with non-contact boxing opportunities should they choose to do so.

Paul Flynn: As boxing is unique in rewarding participants for landing blows to the head and causing damage to that most vulnerable of human organs, the brain—damage that is serious, cumulative and irreversible—should the Government not encourage sports that measure athleticism without inflicting brain damage?

Hugh Robertson: No is the simple answer to that question. Many sports contain an element of risk—riding and cycling, both of which have much higher injury tallies than boxing, come to mind. At London 2012, the majority of injuries were not from boxing, but from other sports. Most young people like an element of risk, and boxing has a really important role to play in encouraging young people to take up sport, particularly in deprived and inner-city areas. I am keen to encourage them to do so.

Jenny Chapman: It is clear that new ways to fund sports and the arts must be found, particularly for local and regional projects. In Darlington, Project Vane involves exciting private sector partners who want to invest in bringing an old arts centre back to life, which may well hold boxing too—

Mr Speaker: Is this a question about boxing?

Jenny Chapman: Yes, indeed, Mr Speaker. May I invite the Minister to look at our bid to the Arts Council for capital investment—there are no ongoing revenue needs requiring public sector investment—to help us to bring that project along?

Hugh Robertson: The best thing to say is that I wish the hon. Lady every good fortune. I am not responsible for the Arts Council—I suspect that a submission from the Minister with responsibility for sports would get a fairly dusty response—but I wish her every good fortune.

Gambling

David Lammy: Whether her Department has commissioned research into the effect of fixed-odds betting terminals on the prevalence of problem gambling; and if she will make a statement.

Hugh Robertson: The Government are aware of the concerns that have been raised about these types of gaming machines and are committed to looking at the evidence around B2 machines and problem gambling. In addition, the Responsible Gambling Trust has recently announced the largest programme of academic research into gaming machines ever undertaken in Britain, which should provide a much better understanding of problem gambling behaviour.

David Lammy: I welcome what the Minister has said. We need an independent look at the seriousness of fixed-odds betting terminals in our country and their prevalence in independent bookmakers. May I ask him to look at the matter with urgency, and not to move forward quickly with the recommendations of the Select Committee on Culture, Media and Sport, which would create an open season for fixed-odds betting terminals across the country?

Hugh Robertson: I entirely acknowledge the concerns that the right hon. Gentleman puts so well. A response to the Committee’s report is due shortly—clearly, once we have that, I will be in a position to say more—but I acknowledge his concerns and the need for proper evidence to underpin our response.

John Whittingdale: I share some of the concerns expressed by the right hon. Member for Tottenham (Mr Lammy), and I urge those who have heard reports about what the Select Committee said to look at the report itself. The report did not say that there should be widespread liberalisation; it said that in specific areas local authorities that had concerns about the number of betting shops could consider whether they might be met by some flexibility in the numbers. I specifically agree with the right hon. Gentleman on the desperate need for more empirical evidence and research in this area. That must be addressed as a priority before we start taking decisions.

Hugh Robertson: I agree entirely.

Broadband

Jonathan Ashworth: How many households receive 2 megabit broadband.

Edward Vaizey: As I have already said, our aim is to have universal 2 megabit broadband available to everyone by 2014. Already, 89.9%—approximately 90%—of people have 2 megabit broadband.

Jonathan Ashworth: I think it was Ofcom that reported recently that approximately 10% of broadband connections —about 2.6 million households—do not have access to 2 megabit broadband. Further to the answer the hon. Gentleman gave to my hon. Friend the Member for Bishop Auckland (Helen Goodman) and my right hon. Friend the Member for East Ham (Stephen Timms), given that access to broadband is vital to building a sustainable, modern economy, why will he not think about introducing a universal service obligation?

Edward Vaizey: I do not think that a universal service obligation would be appropriate for broadband, but, as I have said, we have an ambitious programme, with £500 million going to ensuring that everyone has access to 2 megabit broadband by the end of this Parliament.

Women’s Sport

Julie Hilling: If she will commission an inquiry into the media coverage of women’s sport.

Maria Miller: I am absolutely committed to seeing more coverage of women’s sport, and I support the Women’s Sport and Fitness Foundation’s call for more action in this area. The Olympics and Paralympics showed clearly that there is an appetite for women’s sport, for which the BBC and Channel 4 secured strong audiences. Rather than have an inquiry, I am bringing together broadcasters, journalists and women leaders in sport to ensure more coverage of all our sporting achievements by both men and women.

Julie Hilling: The Women’s Sport and Fitness Foundation says that the media devote about 5% of their sports coverage to women’s sport. However, about 20% of the BBC’s coverage is of women’s sport, which raises questions for other outlets. Some 36% of the medals won at the Olympics were won by women, but women’s sport receives only 0.5% of sport sponsorship. What will the Secretary of State do to tackle this unacceptable situation?

Maria Miller: The hon. Lady has shown that this is not about asking what the problem is—she has clearly articulated it. There is an appetite to watch women’s sport and we need to ensure that it is followed up by more broadcasting and coverage in the press. I was pleased to hear the BBC announce in December that it will broadcast all of England’s UEFA European women’s championship games when the team heads to Sweden in July, and the semi-finals and finals, across BBC 2 and BBC 3. In addition, all other peak-time matches will be broadcast on BBC 3. That is the sort of action we want to see, and it will set a bar for the other channels and media to follow.

Tracey Crouch: The coverage and reporting of women’s sport is incredibly important, but the issue should not be seen in isolation. Will the Secretary of State explain how we can encourage better commercial opportunities in women’s sport, as that will encourage girls and women to participate more?

Maria Miller: My hon. Friend is absolutely right and I know she takes a deep interest in this matter. The sports marketing bureau, which will be launched shortly, will do exactly what she is talking about: highlight marketing opportunities in women’s sport and across the board. We want to see companies capitalising on the clear interest and appetite for women’s sport to ensure that it grows.

Basketball

Sharon Hodgson: If she will request UK Sport to reconsider its decision to withdraw elite funding for basketball.

Hugh Robertson: UK Sport is investing record levels into Olympic and Paralympic sport for the 2016 games. This includes more than £5 million for the wheelchair basketball team. Sadly, the elite Olympic basketball team did not meet the UK Sport investment criteria for this cycle. England Basketball has, however, received £6.75 million from Sport England, including £1.5 million of talent development funding.

Sharon Hodgson: I am sure the Minister is aware, first, that Team GB came within two points of beating Spain, who went on to win the silver medal, and actually beat China, who are top-10 seeded in the world, and secondly that it took hockey more than 20 years of elite-level funding before it received a bronze medal at this year’s Olympics. In the light of that and of my letter to him on 20 December, will he agree to meet me and other members of the all-party group on basketball to discuss this important matter?

Hugh Robertson: I would make two points on that. First, hockey is a good example of what basketball needs to do. It had great success in 1988, with its gold medal, but then went bust and had its funding cut completely for lack of performance. It built itself back up, however, and got itself to the stage where it was medalling again, as it did in London. Secondly, I am aware that basketball has made an appeal to UK Sport. Once we know the result of that, I would be happy to meet the hon. Lady.

Rehman Chishti: UK Sport funding is handed out in a four-year Olympic cycle. Does the Minister believe that that is the right way forward, or does he think there needs to be change?

Hugh Robertson: I am sorry to say it to my hon. Friend, but that is not actually correct. The funding for the Rio cycle includes considerable funding for developing athletes that will take them through to the 2020 games.

Topical Questions

Simon Hart: If she will make a statement on her departmental responsibilities.

Maria Miller: I am pleased that we have started the new year with such a positive set of announcements about the support in the honours system for Olympic and Paralympic athletes. I hope that all hon. Members, on both sides of the House, will join me in congratulating individuals who have received such honours.

Simon Hart: Given that Government funding might not extend rural broadband to really isolated areas, what plans do they have to assist communities in putting in their own piping infrastructure and compelling successful bidders to make use of that?

Maria Miller: In addition to the £56.9 million allocated to Wales as part of the rural broadband programme, a top-up of £4 million is available as part of the rural community broadband fund, which is designed for just the purposes that my hon. Friend has described.

Dan Jarvis: The creative industries and tourism are hugely important sectors, contributing £88 billion each year, or 7% of the UK economy. It was astonishing, therefore, that the coalition’s mid-term review pledges for the remainder of this Parliament made no mention of either of those crucial industries. Which Minister—I do not mind which one—will tell the House why they have dropped the C from DCMS?

Maria Miller: I think the hon. Gentleman needs to be a little more cautious in his comments. He knows absolutely our commitment to the creative industries and to having the infrastructure necessary to ensure that they thrive. The facts speak for themselves, given the progress being made in industries such as the film industry and the gaming industry. I would draw his attention to those facts when he considers this matter further.

Pamela Nash: Earlier this week, a group of respected ex-journalists in Scotland expressed concern that the 120 jobs being cut at BBC Scotland would cause “real damage” to the quality of news and current affairs it is able to produce. Does the Secretary of State agree that this could not happen at a worse time, when the people of Scotland need a fair and well informed debate leading up to the referendum, and will she raise this matter with the BBC Trust?

Maria Miller: It is important—I am sure the hon. Lady will agree—that the BBC is independent of government in these matters, and it is for it to make these decisions. I hear what she says though—it is important that we have a strong BBC in Scotland—and I am sure that her comments will have been noted.

Chris White: I am pleased that the creative industries Minister, the Under-Secretary of State for Culture, Media and Sport, the hon. Member for Wantage (Mr Vaizey), is planning to visit silicon spa in Leamington, which is one of our country’s leading centres for the video games industry. Video games contributed £1.4 billion in exports to the UK economy in 2010, but we often do not promote the sector in the same way as we do our country’s successful film industry. Will he inform the House of what steps the Government are taking to better support this growing sector?

Edward Vaizey: I am delighted to reiterate this Government’s commitment to the creative industries, with the establishment of the creative industries council, the video games tax credit—as well as for high-end television and animation—and the visit of the Minister for creative industries to Leamington Spa in the near future.

Andrew McDonald: How does the Secretary of State expect to inspire the sporting habit for a lifetime in our young people if we are cutting back on spaces where children can play sport in our schools?

Hugh Robertson: The fact is that, for the very first time, under this Government PE is a compulsory element of the curriculum. We could not do any better.

Guy Opperman: May I thank the Minister, who has responsibility for broadband, for meeting me yesterday and for understanding the true complexities in the provision of broadband in Northumberland? Surely the true broadband nirvana for all rural MPs will be when we have the Department for Environment, Food and Rural Affairs, BDUK—Broadband Delivery UK—BT and county councils working as one, in joined-up government.

Edward Vaizey: I had a very enjoyable meeting with my hon. Friend yesterday to discuss the roll-out of broadband for his constituents in Northumberland. I assure him that I will work closely with my DEFRA colleagues to deliver nirvana.

Nick Smith: Given increased concerns about the safety and security of betting shops, what discussions has the Secretary of State had with the Association of British Bookmakers about how it can improve its guidance to shop workers, many of whom are women and many of whom work alone?

Hugh Robertson: I entirely acknowledge the concerns that the hon. Gentleman raises. I have met the Association of British Bookmakers on two occasions. I have to say that on neither occasion has it raised that as a concern—[Hon. Members: “You need to raise it!”]—but once the cheap seats have piped down, I might finish by saying—[Interruption.] Actually, the right hon. and learned Member for Camberwell and Peckham (Ms Harman) is extremely expensive—that St Paul’s education cost a fortune, didn’t it?
	If the hon. Member for Blaenau Gwent (Nick Smith) would like to write me a letter, I will take the matter up with the Association of British Bookmakers.

Edward Leigh: The blue plaque scheme in London is greatly loved. I remember serving on the historic buildings committee of the Greater London council 35 years ago with Sir John Betjeman. When it was abolished, we were given an absolutely firm commitment, by a Conservative Government, that the blue plaque scheme would carry on. Now that it is in danger, will the Minister intervene to stop the silly games between the chief executive officer and the chair of English Heritage and tell them to get a move on and carry on with this much loved scheme?

Mr Speaker: Before the Minister answers, I say to the right hon. Member for Faversham and Mid Kent (Hugh Robertson) that, for the avoidance of doubt, the right hon. and learned Member for Camberwell and Peckham (Ms Harman) is neither cheap nor expensive; she is simply priceless.

Maria Miller: My hon. Friend is right to point out the important role of the blue plaque scheme. The chairman of English Heritage made it clear yesterday that the scheme is continuing, but I am sure that my hon. Friend, in his many roles in the House, would want us to look carefully at how it is run in future, because at the moment we are spending some quarter of a million pounds a year, employing four people putting up six
	plaques a year. I am sure there are different ways that we could run the scheme; and I am sure that consideration will be given in the future to him having his own plaque.

Meg Hillier: In Hackney there are more than 70 betting shops and last year £167 million was spent gambling on fixed-odds betting machines. What further evidence does the Minister need to take action on reducing either the number of machines or the frequency of bets that can be laid, which are taking money from my poorest constituents?

Hugh Robertson: As I have said on a number of occasions today, I recognise the issue that the hon. Lady raises. I assure her that once we have sufficient evidence, if action needs to be taken, it will be, but it has to be taken on the basis of national evidence, not just evidence from individual constituencies.

Julian Sturdy: Given that the grand départ of the Tour de France is coming to God’s own county—namely Yorkshire—in 2014, may I ask the Minister to say what pressure the Government are bringing to bear on UK Sport to support fully Yorkshire’s successful bid to host the start of the world’s biggest annual sporting event?

Hugh Robertson: The Government have to be careful about this, because the money used to support such bids is national lottery funding and so is not open to the Government to direct. My hon. Friend will also be aware that despite the excellence of Yorkshire’s bid, it chose not to be in a position to share the commercial details of the bid with UK Sport before it made it. Now that Yorkshire has won, it is meeting UK Sport. I very much hope that a way will be found to achieve precisely the end that he is advocating.

Bill Esterson: To discourage the closure of libraries such as Aintree library in my constituency, the Government need to ensure that the money is available to keep them open. Will the Secretary of State speak to her colleagues across Government to ensure that the necessary funding is in place to safeguard library services such as those in my constituency that are under threat from cuts to council funding?

Edward Vaizey: This is a time when everyone is having to tighten their belt, and we are clearly having to make savings. If Labour wants to make it clear which cuts it would reverse, it should by all means do so, but these crocodile tears are pointless. The council needs to run its library service; it is responsible for doing that. It should look at Hammersmith and Fulham council, which has closed no libraries and is reducing its council tax.

Nick Harvey: Returning to the question of broadband roll-out, the Minister has reaffirmed the 2015 deadline, and the Policy Exchange report that he commended states that no public money should be made available after that date. Is he aware, however, that there are real practical considerations as to whether it will be possible to complete the programme by 2015, owing to a lack of capacity on the part of BT, even though the funding has been allocated?

Edward Vaizey: We have set aside more than £15 million for broadband roll-out in the hon. Gentleman’s area, and we are confident that we are still working towards our target of 2015. Of course, we have money allocated for broadband after 2015. We have not decided specifically how that money will be used, but we will make a decision on that in the fullness of time.

Valerie Vaz: What representations has the Secretary of State made to the Football Association to request that it issues clear guidance to support players at local and national level who are the subject of homophobic, sexist and racist abuse?

Hugh Robertson: Let me join the hon. Lady in saying that everyone who follows football, and indeed many of those who do not, have been extremely concerned by the increase in the prevalence of racist incidents over the past six months or so. The Football Association has just produced a comprehensive 92-point plan, which has been welcomed by many of those involved in the game, and I very much hope that it will play a significant role in bringing this unfortunate chapter to a close and improving the situation rapidly.

WOMEN AND EQUALITIES

The Minister for Women and Equalities was asked—

Equal Marriage

Penny Mordaunt: What discussions she had with the Church of England prior to her oral statement of 11 December 2012 on the equal marriage consultation.

Maria Miller: Full discussions have been held with the Church of England over the past year, first by my predecessor as part of the public consultations, and by officials, in confidence, as the proposals were being finalised, before my statement to the House. We continue to work with a range of religious bodies, including the Church of England, as the legislation is finalised.

Penny Mordaunt: Will the Minister consider what opportunities an examination of civil marriage and partnerships might bring to those who are not in such a relationship but who share their lives, such as siblings who live together or widows who share a home?

Maria Miller: I understand the importance of the question that my hon. Friend asks, but I would say that the legislation that we are working on is about how we can ensure that marriage is broadened, in terms of the number of people who can participate in it, rather than about broadening civil partnerships.

Diana Johnson: In those discussions, will the Minister be able to raise the issue of the vote in Synod on not allowing women bishops? I am sure that she would like to assist the Church in making progress on that issue.

Maria Miller: We have already had debates in the House on the role of women in the Church, and I note that there are now more women than men being ordained
	in the Church, which is very important. It is a matter for the Church of England to put forward proposals in this area, to ensure that its role is as relevant to our society today as it always has been.

Several hon. Members: rose —

Mr Speaker: On the subject of the equal marriage consultation, I call James Duddridge.

James Duddridge: In the course of her discussions on equal marriage, did the Minister discuss with the Church of England the fact that it would continue to bless marriages, whether of same-sex or opposite-sex couples, that have taken place elsewhere?

Maria Miller: My hon. Friend is absolutely right to say that many churches already offer the opportunity for couples who are in same-sex relationships to have their marriages blessed in church. These are matters for the Church to deal with, whether they relate to the performance of marriages in church or to blessings. The Church must deal with these issues itself.

Kate Green: Is it not unfortunate that the Minister has said that same-sex marriage will be “illegal” in the Church of England and the Church in Wales, when the incoming Archbishop of Canterbury has said that he will carefully consider his stance on the issue and the archbishop of the Church in Wales has said that there is no single Christian opinion on the matter? Will she ensure that, should those Churches wish to marry same-sex couples at some time in the future, she will have legislation prepared to enable them to do so without the need for further primary legislation?

Maria Miller: The hon. Lady is right to raise the issue of the role of the Church of England and the Church in Wales. Our stance throughout has been to protect those organisations to enable them to make their own decisions. We are talking to them on an ongoing basis about the best way to do that. As to her question about whether they would be able to undertake these duties in the future if they decide to do so, the answer is absolutely yes.

Tax and Benefits

Mary Glindon: What assessment she has made of the implications for her policies on women of recent tax and benefit changes.

Maria Miller: Departments always take full account of the impact on women of their policies, and the Government are supporting women and their families, for example by extending child care through universal credit and by lifting 2 million of the lowest paid workers—of whom six out of 10 are women—out of income tax altogether,.

Mary Glindon: Research from the House of Commons Library shows that women will be hit four times harder by incoming direct tax, tax credit and benefit changes.
	Will the Minister tell us why she allowed the Chancellor to get away with treating women so unfairly in his autumn statement?

Maria Miller: The hon. Lady needs to look at the total package of measures brought forward in the autumn statement. We are absolutely mindful of the need to make sure that we support those who find it most difficult in today’s society. That is why 1 million women have been taken out of tax altogether and why we are putting £200 million more into child care for people who are working the shortest hours. Those are things have never happened before, and I hope the hon. Lady will applaud and welcome those measures.

Tessa Munt: On 5 January last Saturday, BBC Radio 6 Music made history when three consecutive daytime programmes were presented by female DJs for the first time in the BBC’s 45 years of music radio. While less than 20% of the BBC’s music radio programmes were presented by women in 2012, will the Secretary of State please continue her discussions with the BBC to correct that imbalance?

Maria Miller: I am wondering how that question relates to tax and benefit changes, but I will of course always encourage the BBC to make sure that women have a full role in the work they do.

Yvette Cooper: The Minister will agree that it is really important for pregnant women to be able to afford to eat healthily and to take their full maternity leave when the baby is born, so why is she cutting £180 from maternity pay, cutting more than £1,000 in tax credits and, according to the House of Commons Library, even including the tax allowances that she mentioned, cutting a total of £1,300 from new mums on low income, yet giving a £13,000 tax cut to someone—usually a man—who is earning over £400,000 a year? In her role as the Minister for Women and Equalities, did she even try to stop the Chancellor hitting women, especially new mothers, so hard?

Maria Miller: The right hon. Lady will have heard my response to her colleague earlier—the Treasury is looking at the detail of how its policies impact on various groups and has made it an absolute priority to give support to those who need it most, ensuring that more families are able to get into work and that work pays for more people. Above all else, it is making sure that our children do not have to deal in the future with the record levels of deficit left by the right hon. Lady’s Government.

Andrea Leadsom: Does my right hon. Friend share my astonishment that Opposition Members always want to emphasise the plight of women? Is she as delighted as I am about the growing numbers of health visitors, the growing numbers of nursery places for disadvantaged two-year-olds and the tax-free allowances that directly affect so many women and make their lives so much better under this Government?

Maria Miller: My hon. Friend is absolutely right. We want to target support effectively in our communities, and I think that, whether we look at the role of Sure Start centres or the role of health visitors, the changes that have been made are plain to see.

William Bain: According to the impact assessment relating to the Welfare Benefits Up-rating Bill, 2 million lone parents, 90% of them women, will be affected by this measure. Why does the Minister think it fair for millionaires to be given a tax cut of more than £2,000 a week while 1.8 million women bringing up children lose an average of £5 a week?

Maria Miller: An impact assessment relating to a benefit that is predominantly claimed by women will, of course, predict the impact that the hon. Gentleman has described. We need to ensure that families across the board receive the support that will enable them to get into work that pays, and the support that they require for the future.

Income

Sandra Osborne: What her policy is on women’s incomes.

Jo Swinson: The Government are committed to reducing the pay gap and guaranteeing equal pay for women. The latest figure, based on median earnings, shows that the pay gap continues to narrow and currently stands at 19.7% for all employees, but there is, of course, much more to be done, because the existence of a pay gap is unacceptable.
	We are making good progress with “Think, Act, Report”, which promotes gender equality and transparency. More than 60 major companies have signed up to it, representing more than 1.2 million people and more than 11% of the target work force.

Sandra Osborne: What assessment has the Minister made of the impact on the retirement incomes of low-paid women of excluding all those who earn less than £9,440 a year from the new workplace pensions? Does she realise that 1 million people who could be saving for the future are being left out in the cold, and that 77% of them are women?

Jo Swinson: Saving for pensions is very important. That is why the Minister of State, Department for Work and Pensions, my hon. Friend the Member for Thornbury and Yate (Steve Webb), has been promoting workplace pensions. We are introducing the system gradually, because suddenly having to pay money into their pensions that they have not previously had to pay could have a real impact on people’s current incomes, but our plan is, over time, to ensure that everyone saves for a pension.

Julian Huppert: Does my hon. Friend agree that the introduction of shared parental leave will lead to more equality in the workplace, including equality in incomes? Men will be encouraged to take a greater share of child care, which will allow women to return to work earlier if they wish to do so.

Jo Swinson: I wholeheartedly agree with my hon. Friend. Shared parental leave is crucial in not just enabling families to share the care of their children in a way that works for them, but dealing with some of the inequalities which, sadly, persist in the workplace. We know, for example, that maternity discrimination still
	goes on. One of the positive side-effects of shared parental leave will be the reduction of incentives for employers who have been tempted to break the law, and who may now decide that that is not a sensible thing to do.

Same-sex Marriage

Stephen Gilbert: What representations she has received from the Church of England on the proposed prohibition on that organisation offering same-sex marriages.

Maria Miller: The views of the Church of England were considered during the finalising of the proposals on equal marriage. The Church has made clear that it does not want to permit marriages of same-sex couples to take place according to its rites, but, should it change its mind, it will be able to make any amendments that are necessary to its canon law and to the relevant primary legislation in order for that to happen. We continue to engage in constructive dialogue as we prepare to introduce legislation to Parliament.

Stephen Gilbert: It seems that we are shortly to have gay bishops in the Church of England, but not women bishops. The gay bishops will be able to conduct marriages between opposite-sex couples, bisexuals and transsexuals, but will not be able to marry same-sex couples or, indeed, get married themselves. Is not our established Church in a bit of a mess on these issues?

Maria Miller: I understand the hon. Gentleman’s point, but I think that what is important when it comes to thinking about equal marriage, particularly as we proceed with our legislation, is that we show respect for all views in all our debates. It is for the Church of England to ensure that it has in place the proposals that are right for it.

Mark Durkan: Many of us can fully rationalise and justify voting for civil marriage between same-sex couples, and also for removing the legal impediment that prevents any Church that wishes to do so from marrying same-sex couples, but how can we also be asked to justify voting for a legal impediment in relation to one Church alone? Does that not invite all of us to add personal absurdity to all the anomalies and anachronisms to which the hon. Member for St Austell and Newquay (Stephen Gilbert) just referred?

Maria Miller: The hon. Gentleman needs to understand that not all Churches have the same governance structures in place. Therefore, the legislation we introduce needs to recognise the different position of the Church of England and the Church in Wales. I am sure that when he looks at the legislation he will see that we are amply dealing with the question of the important protections each of those individual religious organisations require.

David Burrowes: This question of religious safeguards is an issue of conscience that will rightly be determined by free votes across the House. Does my right hon. Friend agree that the proper
	way to address such an issue of conscience is through a Committee of the whole House, as has happened in the past?

Maria Miller: My hon. Friend is right to say that from the start our party has wanted to listen to all views on this issue. Questions to do with the proceedings of the House are matters for the Chief Whip and the Leader of the House, and I am sure they will have heard his comments.

Chris Bryant: I agree with the point made by the hon. Member for Enfield, Southgate (Mr Burrowes). I do not think the Minister understands the policy in relation to the Church of England and the Church in Wales. It is ludicrous to introduce a complete prohibition in respect of these two Churches. Would it not make far more sense to do what the Matrimonial Causes Acts did? They just said that no minister of religion shall be required to marry a divorcee, and in this case we should say they shall not be required to conduct a same-sex marriage.

Maria Miller: We have, as the hon. Gentleman would expect, spent a great deal of time talking to the different religious institutions, including the Church of England, and they have very clearly said that at this point in time they do not wish to be able to perform same-sex marriages. We are protecting the Church of England and its particular position with regard to common law and canon law, and making sure that it can opt in at a later time if it thinks that is right.

Autumn Statement

Alex Cunningham: What discussions she has had with the Chancellor of the Exchequer on the effect of the autumn statement on women, black and minority ethnic groups and older people.

Helen Grant: Colleagues have had discussions with the Chancellor and others on the impact of tax and benefits changes. The Government are committed
	to fairness and look very closely and carefully at the effects of their decisions on different groups, including women, black and minority ethnic groups and older people.

Alex Cunningham: Evidence from the House of Commons Library contradicts what the Minister has said, because it shows that women are shouldering almost three quarters of the cumulative impact of the net direct tax, benefit, pay and pension changes pursued by the coalition Government. Does she believe this blind spot on women reflects the fact that there are so few women in the Government?

Helen Grant: We have lifted 1 million women out of having to pay tax and put an additional £200 million into child care support, and under this Government we have seen the highest number of women in work. That proves beyond doubt our commitment to women and their families.

Government Equalities Office

Edward Leigh: What steps she is taking to improve cost-effectiveness and value for money in the Government Equalities Office.

Maria Miller: In light of the 38% reduction in the equalities budget in the 2010 spending review, the Government Equalities Office is pursuing efficiency measures, enabling it to do more with less resource while maintaining high quality.

Edward Leigh: What progress has been made in ensuring equality in the Government Equalities Office since June 2011, given that a report found then that there was a gender imbalance of two-thirds in favour of women and women in the office were on average paid 7.7% more than men? Are men not equal to women?

Maria Miller: As I am sure my hon. Friend would expect, I want to make sure the GOE is doing what it needs to do to promote equality in its own ranks, and I will certainly look in detail at the points he has raised.

Business of the House

Angela Eagle: Will the Leader of the House give us the business for next week?

Andrew Lansley: Mr Speaker, may I wish you and the House a happy and peaceful new year?
	The business for next week will be as follows:
	Monday 14 January—Second Reading of the Crime and Courts Bill [Lords].
	Tuesday 15 January—A motion to approve the draft Scotland Act 1998 (Modification of Schedule 5) Order 2013.
	Wednesday 16 January—Opposition day [14th allotted day]. There will be a debate on an Opposition motion. Subject to be announced.
	Thursday 17 January—A general debate on Atos work capability assessments, followed by a general debate on the nuclear deterrent. The subjects for these debates were nominated by the Backbench Business Committee.
	Friday 18 January—Private Members’ Bills.
	The provisional business for the following week will include:
	Monday 21 January—Consideration in Committee and remaining stages of the Welfare Benefits Up-rating Bill.
	Tuesday 22 January—Consideration of an allocation of time motion, followed by proceedings on Second Reading and in Committee of the whole House on the Succession to the Crown Bill.
	Wednesday 23 January—Opposition day [15th allotted day]. There will be a debate on an Opposition motion. Subject to be announced.
	Thursday 24 January—Debate on a motion relating to reducing the voting age, followed by a general debate on the Holocaust memorial day. The subjects for those debates were nominated by the Backbench Business Committee.
	Friday 25 January—Private Members’ Bills.
	I should also like to inform the House that the business in Westminster Hall for 24 January will be:
	Thursday 24 January—Debate on the first report of the Justice Committee on post-legislative scrutiny of the Freedom of Information Act 2000.
	May I also take this opportunity, on behalf of the House, to offer our congratulations to the Members of this House whose public service has been recognised in the new year honours? May I also say how pleased we are by the awarding of Knight Commander of the Order of the Bath to the Clerk of the House? That reflects his fine public service and leadership, and is a tribute to the House service as a whole.

Angela Eagle: I thank the Leader of the House for announcing the business for next week, and may I join him in wishing you, Mr Speaker, all Members of this House and all the staff who work here a happy new year? I would also like to join him in his congratulations to those who were recognised in the new year’s honours list.
	The ongoing disturbances in Northern Ireland concern Members from all parts of the House. More than 3,000 people were killed during the troubles. The peace process has brought to Northern Ireland hope and greater security, and has helped to attract much-needed investment. Those whose only aim is to bring down the peace process are exploiting events in Belfast, and we must not let a small minority undermine all that has been achieved since the Good Friday agreement. May I thank the Leader of the House for arranging a statement from the Northern Ireland Secretary following business questions? Will he undertake to ensure that she keeps the House regularly updated?
	On Tuesday, the House considered the Welfare Benefits Up-rating Bill, and there is more of it to come. The Government have refused to let the Bill have pre-legislative scrutiny and are intent on forcing it through the House in just one more day. Ministers are running scared of scrutiny because they do not want the facts to get in the way of their nasty little caricatures of those who rely on social security. The facts are that 7 million households affected by this legislation are in work; and the Government’s own impact assessment, published at the last minute on Tuesday, thus preventing Members from scrutinising it before the debate, shows that those who lose the most from these measures will be the poorest 10% of households. So can the Leader of the House explain why there is no pre-legislative scrutiny for this Bill, unlike almost all other bills this Session, and look again at the timetabling of this legislation?
	Did the right hon. Gentleman find time this morning to tune into the Deputy Prime Minister’s new, gripping, radio show? No doubt, like all Conservative MPs, he has cleared his diary so as not to miss a broadcast. I am sorry to say that expectations were not high among Government Back Benchers, with the view of the hon. Member for Bridgwater and West Somerset (Mr Liddell-Grainger) being:
	“Having sat and listened to him at Deputy Prime Minister’s questions, he has never answered a question yet so he isn’t likely to break the habit of a lifetime on radio.”
	Having listened to the broadcast this morning—it was half an hour of my life that I will never get back—I have to report to the House that the Deputy Prime Minister did not break the habit. However, I have discovered that, strangely, although the Deputy Prime Minister is keen to do a London phone-in, yesterday he refused to appear on a Radio Sheffield show to answer questions about the impact of Government cuts in his own constituency. As the Deputy Prime Minister clearly has time on his hands, could the Leader of the House make a change to future business to accommodate a statement on why the Liberal Democrat leader is hiding from the people of Sheffield?
	I pay tribute to the former Leader of the House of Lords, Lord Strathclyde, who has decided to leave the Government because he is fed up of having to deal with the Liberal Democrats. If every Conservative Member who was fed up with the Liberal Democrats abandoned politics, the only Tory left in the Government would be the Prime Minister.
	This week, the PR Prime Minister managed to bungle his own Government relaunch. First, two Ministers resigned because they had had enough of the coalition and then we had the shambles of the Government’s self-audit. Having put together a document allegedly
	auditing their first two and half years, Ministers realised, as the memo put it, that it had “problematic areas” that would lead to “unfavourable copy” as a result of identifying “broken” promises. On Monday at the relaunch, there was no audit. It is a unique interpretation of Government transparency first to decide against publishing a so-called audit, only to have to retrieve it from the waste paper bin after a bungling aide inadvertently revealed its existence to the media. I have had a look at what is actually in the document. There is no mention of the cost of living going up, nurse and police numbers going down and the economy flatlining. Who is the Prime Minister trying to kid? Seventy broken promises is just the start. It does not say Ronseal on this tin; it says whitewash.
	There you have it, Mr Speaker, in one week: a botched relaunch, a cover-up and a whitewash. This just proves that with this Government an omnishambles is not just for Christmas.

Andrew Lansley: I am grateful to the shadow Leader of the House. Perhaps it should fall to me to express our appreciation of Lord Strathclyde and his fabulous service over many years. He was leader of the Conservatives in the Lords for 14 years and Leader of the House since the election; he has an exemplary record of public service and we in this House, although we do not normally comment on matters in another place, have benefited many times from how he fostered co-operation between the two Houses. We should certainly thank him for that.
	The shadow Leader of the House is right that it is the Government’s intention and that of my right hon. Friend the Secretary of State for Northern Ireland to keep the House fully informed. My right hon. Friend has made statements and she will do so again today. I share with the shadow Leader of the House the view that those engaging in violence in Northern Ireland are attacking the character and nature of Britain and the flag that represents the United Kingdom as a whole. As the Prime Minister rightly said in Prime Minister’s questions yesterday, we should be working towards a shared future. There is a tremendous opportunity of which we have seen evidence in Northern Ireland and I hope the statement today will further reiterate this House’s support for those in Northern Ireland who are making that shared future a reality.
	The hon. Lady asked about the Welfare Benefits Up-rating Bill. It is a short, simple Bill and what it sets out to achieve is very clear. I do not see any case for pre-legislative scrutiny of a Bill with such a character. More to the point, I think the debate the other day was not about scrutiny of the Bill but about differences of view about how to take forward deficit reduction. The Government recognise that it is a necessity, that everybody must play their part and that it was not acceptable for out-of-work benefits to continue to increase at twice the rate of increases for those who were earning. We are supporting those in work, giving them opportunities by reducing taxation. Some 24 million people have seen their tax bill come down as a consequence of the increase in the personal tax allowance and those on the minimum wage have seen their tax bill halved. That is the right way to go—it is about everyone participating in deficit reduction, but those who are most in need should get the greatest support.
	I must confess to the shadow Leader of the House that I did not have an opportunity this morning to listen to LBC and the Deputy Prime Minister because I was preparing for questions in this House. However, I regularly attend and listen to the Deputy Prime Minister as he responds to questions in this House, as he did earlier this week. I thought he did so admirably.
	Finally, the Government were always going to publish the audit. It is obvious that compared with the previous Government, this Government have been transparent, clear and accountable both in what we have set out to do under the coalition programme and in what we have achieved, and 90% achievement in just over half of a Parliament is a record that we can be proud of.

Fiona Bruce: Further to the question raised a few minutes ago in Women and Equalities questions by my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), has the Leader of the House considered the importance of holding the Committee stage of the House’s deliberations on changes to the marriage legislation in a Committee of the whole House, bearing in mind that this is a free vote conscience issue?

Andrew Lansley: It is not the case that issues of conscience in a piece of legislation are always considered in a Committee of the whole House. It is a matter for further discussion on how we take the Bill forward, as we have not yet introduced it. I am sure that, at that time, I will have the opportunity to inform the House about our plans for effective scrutiny of the legislation.

Dave Watts: Will the Leader of the House find time to have a debate on the impact that benefits, housing and tax changes will have on poverty levels in the UK, and will he tell us when the Prime Minister will visit a food bank?

Andrew Lansley: It is interesting that when it comes to tackling poverty, the hon. Gentleman might have included in his list of things that impact on poverty the extent to which people are in work. The level of poverty in this country is not simply a product of the redistributive changes by Government. It is about getting people into work, and one of the central achievements of this country over that past two and a half years has been—we can see it in the contrast between the United Kingdom and many other European countries—the extent to which the private sector is creating jobs and people are going into work. As has been acknowledged by Labour Members, although they appear not to follow through the logic, work is the best means of escaping poverty.

Tony Baldry: When he considers business for next week and the coming few weeks, may I urge my right hon. Friend not to rush bringing forward the legislation on same-sex marriage until Government officials and officials in the Church of England and other faith groups have agreed the draft clauses that will give protection to Churches and faith groups that do not wish to perform same-sex marriages, and have agreed that those clauses will do what they say on the tin? Whatever the views of the Church of England and other faith groups might be on same-sex marriage, I am sure the Leader of the House will agree that it is in everyone’s interests that we get the quadruple lock
	provision properly sorted, and that it will not help the Government’s handling of the measure if there is any confusion about these provisions on Second Reading.

Andrew Lansley: It is absolutely our intention to ensure that the legislation that comes forward is clear and will carry support. To that end I am grateful not only to my hon. Friend but to representatives of the Church of England for enabling us to have those conversations before the Bill is introduced.

Barry Sheerman: May I push the Leader of the House to arrange an early debate on post-natal depression, which affects about 20,000 women a year in this country? It is the most likely cause of death in young women between the ages of 18 and 40 by suicide. It is a very neglected area and the sooner we tackle it and give it higher visibility, the better.

Andrew Lansley: The hon. Gentleman may recall that in the summer of last year, when I was Secretary of State for Health, one of the things that I set out as part of the further measures to improve maternity services, was a focus on post-natal depression. I entirely share his view. There is still, as I know from my knowledge of the health service, variable access to specialist services for some of the most severe cases of post-natal depression. I know my colleagues will be looking at that, but if the hon. Gentleman wishes to raise the matter at Health questions next Tuesday, I am sure that would be helpful too.

Christopher Chope: Will it be possible to have a debate next week on the issue of collective ministerial responsibility? I tabled a number of questions to the Prime Minister on the subject, which have been ducked. Surely it is important that there should be clarification of what we mean by collective ministerial responsibility, and how and to what extent the Prime Minister feels obliged to enforce the provisions of the ministerial code in relation to collective ministerial responsibility.

Andrew Lansley: I am grateful to my hon. Friend. I have not had the opportunity to see the questions to which he refers, although I would be glad to. As far as I am aware, collective ministerial responsibility continues to apply as it always has done, as has the ministerial code.

Ian Lucas: On the question of keeping the House informed, before Christmas I asked the Minister for Policing and Criminal Justice about proposals for new prisons in north Wales, but he refused to meet Members of Parliament from north Wales. As we speak, the Department is briefing journalists on new prisons and on a super-prison that might be placed in north Wales. Why are the Government so disrespectful of Members of this House that they are briefing Lobby journalists, rather than Members of Parliament, on the matter, which is of profound concern to my constituents?

Andrew Lansley: I am not sure whether the hon. Gentleman is aware that a written ministerial statement was laid before the House this morning—[ Interruption. ] He says
	that he wants an oral statement. The Lord Chancellor and Secretary of State for Justice laid a written ministerial statement that is very full and detailed, and there will, of course, be opportunities in future, for example during Justice questions, for Members to ask questions on that.

Peter Bone: In the past half hour my hon. Friends the Members for Congleton (Fiona Bruce) and for Enfield, Southgate (Mr Burrowes), the hon. Member for Rhondda (Chris Bryant) and my hon. Friend the Member for Banbury (Sir Tony Baldry) have all questioned the length of time there will be for discussions on the Bill to equalise marriage, and it seems to me that a Committee of the whole House is the answer. Previously, when the Leader of the House, as shadow Health Secretary, was involved when a conscience issue came before the House, it was considered in a Committee of the whole House, so will he reconsider his position and ensure that the Bill is considered in a Committee of the whole House?

Andrew Lansley: I reiterate that in the past conscience issues, including those that have been the subject of free votes by virtue of that fact, have not necessarily been considered by a Committee of the whole House. There is a job to be done in scrutinising legislation, which can sometimes be best achieved in Committee, and all Members have an opportunity to participate in the debate on Report, particularly if sufficient time is available. I am not prejudging the question of the equal marriage Bill at all, as it has not been introduced and I have not announced how we propose the business should be taken forward.

Pete Wishart: Next Tuesday we will discuss the important section 30 order, which will allow for a legally binding referendum on Scottish independence to be determined by the Scottish Government. Many of the Leader of the House’s hon. Friends are not particularly well disposed to that idea and might be tempted to vote against the measure. Can he assure me that there will be a three-line Government Whip for attendance to ensure that any rebellion is defeated?

Andrew Lansley: If I may say so, it is sufficient that I deal with the business of the House, rather than attempting to answer questions relating to the whipping arrangements of each individual party. Suffice it to say, the matter will be brought forward on a Government motion.

Matthew Offord: Many of my constituents contact me about asylum and visa applications, and when my office investigates with the UK Border Agency we see that the personal data held by the agency are woefully out of date. Will a Minister come to the Dispatch Box to explain what the Department is doing to ensure that UKBA is not only fit for purpose, but keeps up-to-date personal records?

Andrew Lansley: My hon. Friend will know that the UK Border Agency is developing a strategy to identify and resolve data issues, not least in response to a recommendation of the chief inspector of borders and immigration. That should ensure the quality of data and assist the agency in cleansing the data records on
	the system. If my hon. Friend has specific examples of constituents affected, I am sure that it would be helpful if he raised those with Home Office colleagues. We know that the UK Border Agency had a poor record in the past. The process of turning that around has begun and is progressing, but it will take time.

Luciana Berger: Further to the question from my hon. Friend the Member for St Helens North (Mr Watts), any time a Minister is asked about food poverty, their response is that we have seen jobs created in the private sector. I am shocked that the Government are not aware that working people are accessing emergency food aid in this country. When will the Prime Minister, the Deputy Prime Minister, the Chancellor, or a Minister from the Department for Work and Pensions or the Department for Environment, Food and Rural Affairs actually visit a food bank so that they can give more informed responses to the questions asked by Labour MPs?

Andrew Lansley: I am surprised that the hon. Lady should think that we have not done that, although I can speak only for myself; I have not checked with other Ministers. For example, my hon. Friend the Member for Loughborough (Nicky Morgan) and I visited a food bank in her constituency in the early part of last year or thereabouts. I completely understand the concern, of course. Access to food banks has been increased, and that is absolutely right. It is right that people should have access to food banks, and there is better access than there used to be in the past. We are setting out to ensure that those who are in the greatest need get the greatest support. However, it is not simply a matter of public sector support; it is about giving people the opportunity to have the dignity and independence that comes with work and earnings.

David Nuttall: Following the recent announcement by the would-be state nannies in the Labour party that they think that the content of breakfast cereals should be regulated, which will put our Sugar Puffs and our Frosties under threat, may we please have a debate on how we can best protect these great British cereals from this unwarranted attack before anyone starts suggesting that they should be put in plain packages?

Andrew Lansley: At the weekend I was rather staggered by the effrontery of Labour Members, who, in the course of their 13 years in office, presided over what was, in effect, a doubling of obesity, in then saying that something should be done and, in particular, proposing legislation when in those 13 years they proposed no such legislation themselves. They are clearly amusing themselves with the luxuries of opposition. The fact is that in government we have done more in two and a half years to tackle these issues than the Labour party did in 13 years.
	On the question of cereals, the evidence is that a voluntary approach can make more progress more quickly, and that is what the responsibility deal is doing. We have achieved that in relation to salt. In particular, it has enabled us to take full account, in a practical and effective way, of consumer preference and consumer taste. We can shift consumer taste and reduce salt in cereals, and the public will continue to buy them. Even
	Mr Speaker might buy cereals in the morning and not notice that the salt content has been reduced. Reducing sugar is tough because it impacts on taste, but it does not get us anywhere—
	[
	Interruption.
	]
	I did not even have Weetabix this morning. Reducing sugar in cereals through legislation does not get us anywhere if the consequence is that people simply start sprinkling sugar on their cereals. If we tackle the problem in a way that works effectively through the responsibility deal, that is a more long-term and sustainable approach.

Meg Hillier: Over the weekend we read a great deal of what was provided to Lobby journalists about the Government’s plans for the future of child care, yet when the Prime Minister and the Deputy Prime Minister relaunched the Government on Monday afternoon we heard no detail about their plans. When will a Minister come to this House to lead a debate or make a statement so that Members can contribute on the issue of the future of child care, which is such an important one for most of my constituents?

Andrew Lansley: The Prime Minister and the Deputy Prime Minister were very clear on behalf of the coalition Government in setting out some further directions, one of which, rightly, was investment in the future of child care. They made it very clear that over coming weeks further announcements will be made, and of course they will be made, as is proper, first to this House.

Tessa Munt: Will the Leader of the House note my sorrow to hear today that Shepton Mallet prison is to close—a prison where most prisoners are working? The most recent report and several previous reports have said that it is a settled and remarkably safe prison for prisoners, staff and visitors. Will he recognise the leadership of Andy Rogers, who is the governor, and his team of very dedicated staff, and note that such decisions on closure affect not only money but jobs in the prison and for those who serve it in an area without many alternatives?

Andrew Lansley: I know that my colleagues at the Ministry of Justice will read what my hon. Friend has just said in response to this morning’s written ministerial statement and there will be opportunities in the future to discuss these issues. I will take this opportunity, as she has asked, to pay tribute to not only Andy Rogers, but to those working in the Prison Service, who do an often thankless and difficult task very well.

David Hanson: There is an urgent need for prison places in north Wales and today’s statement indicates that it is a possible option for a super-prison, but, like my hon. Friend the Member for Wrexham (Ian Lucas), I am concerned that we do not have the opportunity to question the Secretary of State for Justice today. May we have an early debate on the provision of prison places, and could the Leader of the House gently suggest to the Justice Secretary that, given that he was at the Dispatch Box yesterday talking about rehabilitation and prisons, he may have had an opportunity to make these announcements then so that we could have questioned him in this House?

Andrew Lansley: As I said to the hon. Member for Wrexham (Ian Lucas), a written ministerial statement setting out what are, frankly, detailed and substantial issues was placed before and announced first to the House. There will be both formal and informal opportunities for Members to get together with Justice Ministers to discuss how to take this forward.

Bob Blackman: At this time of year, local authorities are determining their budgets. Harrow council, uniquely in London, is increasing its council tax by 2%, while Hammersmith and Fulham is reducing it for the sixth time in seven years. May we have a debate in Government time about what is happening to Government money in local authorities and expose the wastage in Labour-run authorities?

Andrew Lansley: If I recall correctly—I will correct myself if I am wrong—we have had a debate on the local government finance settlement. It is important that we in the House vote for resources to support local government, but it is the responsibility of local government to use those resources effectively and to secure value for money. I know that many authorities are achieving that, but others—I look to the Labour party to explain some of them—are not achieving value for money in what are, frankly, tough financial times. I hope that all authorities will achieve best practice in terms of value for money.

Bill Esterson: The Academies Commission has released disturbing evidence of the selection of some pupils at the expense of those from disadvantaged communities. At the same time, we hear reports of academies being run for profit, which the Education Secretary has previously denied. May we have a debate about the future of academies so that both those very important issues can be addressed in this House?

Andrew Lansley: Following the passage of the Academies Act 2010, the expansion in the number of academies is a great success of which this coalition Government are very proud. The hon. Gentleman says that the Academies Commission has produced evidence. I have not had an opportunity to read it myself, but the press reports that I have seen do not suggest that it was more than limited, anecdotal evidence. I am not sure that there is any substantial body of evidence. On schools and profit distribution, the position is exactly as my right hon. Friend the Education Secretary has said: they are not permitted under the legislation to distribute profits.

Mark Pritchard: May we have a debate on the integrity of Government consultations? Following representations from my local Sikh community, will the Leader of the House inform Members how Sikhs up and down the land were consulted on proposed legislation for same-sex marriage?

Andrew Lansley: I am not sure whether my hon. Friend had occasion to catch Mr Speaker’s eye in order to ask that question of the Minister for Women and Equalities earlier. He will know that the consultation on theses issues was substantial and attracted hundreds of thousands of responses. I have no doubt that the Sikh community will have been represented in those responses, but I will gladly ask my right hon. Friend at the Department for Culture, Media and Sport to secure a specific reply.

Kevin Brennan: May we have a debate on Government transparency, because the Government are telling us not what we need to know, but what we do not want to know? The Department for Education has answered only one freedom of information request in the past nine months, yet on “Call Clegg” this morning the Deputy Prime Minister felt the need to tell the nation that he owned a green onesie, although he has not yet worn it. Is that the sort of information that the public really need to know? How many Ministers own a onesie? The nation should be told!

Andrew Lansley: I am beginning to think that the best preparation for business questions would be to listen to LBC radio on a Thursday morning. I clearly missed out. I find it incredible that the Department for Education could have responded to only one freedom of information request. Any Department that I have been in has replied to freedom of information requests by the dozen on a weekly basis.

Andrea Leadsom: At a time of great change in the EU and in Britain’s relationship with it, has my right hon. Friend given any thought to improving the level of scrutiny in this place, for example by improving the use of specialist Select Committees to scrutinise EU legislation, promoting the post of Minister for Europe to a Cabinet position and periodically considering European business in this Chamber, rather than always considering Westminster business?

Andrew Lansley: My hon. Friend will be aware that the European Scrutiny Committee is conducting an inquiry into European scrutiny, which Her Majesty’s Government have welcomed. She makes an important point about the wider use of the expertise of departmental Select Committees in European scrutiny. I hope that that will be taken forward. We look forward to seeing the report of the European Scrutiny Committee. Questions on European business may be asked of the Foreign and Commonwealth Office. In addition, European legislation impacts on the policies of many Departments and so can be raised at many Question Times.

Paul Flynn: As the nations of Britain have waited three centuries for an opportunity to reform the undemocratic anachronism of the choice of Head of State, is it not unseemly to rush the legislation through both Houses in a single day, thereby denying the House the opportunity to give the nations a choice over the next Head of State by referendum, so that they can choose whether they want Charles, William or Citizen A. N. Other?

Andrew Lansley: The Government have no intention of doing what the hon. Gentleman asks. I reiterate that from the business that I have announced, it is clear that we are proposing that the Succession to the Crown Bill should be considered on Second Reading and in Committee of the whole House on the first day. There will therefore be two days of debate in this House, each of which will have proceedings that are amendable.

Andrew Stephenson: In April, the Government will cut income tax for 33,340 working people in Pendle and lift 1,570 of the lowest-paid workers out of paying income tax altogether. That is in stark
	contrast to the previous Government, who abolished the 10p tax rate. May we therefore have a debate on supporting hard-working families and ensuring that they can keep more of the money that they earn?

Andrew Lansley: My hon. Friend makes an important point admirably. I hope that in our further debate on the Welfare Benefits Up-rating Bill, people will recognise that the changes to personal tax allowances will take a lot of low-income workers out of tax altogether and reduce the tax bill for many millions of people.

Lyn Brown: I attended Culture, Media and Sport questions this morning in the hope of asking a question about the gambling prevalence survey, but there was so much interest in that matter in the House that it was oversubscribed. I therefore ask the Leader of the House to consider having a debate in Government time on the proliferation of betting shops on the high street in the hope that the concern will ensure that the Government put into action their rhetoric on localism and allow local authorities the right to control the number of betting shops on their high streets.

Andrew Lansley: If I may, I will ask my colleagues at the Department for Communities and Local Government to respond. I am aware that it has considered issues relating to the licensing of betting shops in local areas, so it is perhaps best that it replies on that specific matter. Given the comments from across the House, this might be an issue that the hon. Lady and other Members would like to invite the Backbench Business Committee to pursue.

Lyn Brown: I am not a Back Bencher.

Andrew Lansley: Perhaps other Members, with the hon. Lady’s support, would like to ask the Backbench Business Committee whether this issue can be brought forward for discussion.

Philip Davies: May we have a debate about attacks on public service workers, particularly teachers, people in the NHS, and police officers? Over Christmas we had the appalling example of a thug who violently assaulted a headmistress, abused and punched her, but simply walked away with a community service order and having to give her £100 in compensation. Surely such crimes should always be dealt with by a prison sentence. May we have a debate to find out what we can do to protect public servants from such attacks and ensure that the perpetrators of such violence are always sent to prison?

Andrew Lansley: I completely understand, and my hon. Friend makes an important point very well. I recall, particularly in relation to the health service, how strongly we felt that on many occasions too few attacks had been followed up, and that too few cases had led to appropriate action. The Government were looking at the extent to which such issues were taken into account as an aggravating factor in sentencing, but I will ask my colleagues at the Ministry of Justice to look at the issue and respond to my hon. Friend.

Valerie Vaz: Sixty per cent. of agricultural land in countries such as Burma and Indonesia that have serious hunger problems have been subjected to land grab. Given that the UK has the presidency of
	the G8 summit, may we have an urgent debate on how we can use that presidency to stop such practices and return the land to the people who live on it so that they can feed themselves?

Andrew Lansley: Yes, I am interested in the subject raised by the hon. Lady although I do not think it is one of the issues set as a priority for the upcoming G8 summit. Such summits always afford opportunities, however, not least because of the increasing influence that we are able to exert through the strength of our overseas aid programme and the like. I will therefore talk to my hon. Friends to see whether we can continue to follow up strongly the issues raised by the hon. Lady.

Marcus Jones: With new car registrations at a four-year high and record exports for our motor manufacturers, many of our car makers are now looking to repatriate their supply chain, to the benefit of areas such as Coventry and Warwickshire. Skills, however, are an issue so may we have a debate on that and on how we can encourage our young people into manufacturing industries?

Andrew Lansley: Yes, my hon. Friend makes an important point and he will have welcomed, as I did, what our right hon. Friend, the Secretary of State for Business, Innovation and Skills said last year about supporting a supply chain initiative. It is important that we perform strongly in the motor vehicle industry, and that can have considerable multiplier effects. My hon. Friend is right about skills and the Under-Secretary of State for Skills, my hon. Friend the Member for West Suffolk (Matthew Hancock) is this morning making clear the Government’s support for initial traineeships—a sort of pre-apprenticeship programme—to ensure that we do not have an economy in which any of our young people go without access to skills and training, and so that we can provide all levels of skills to industry.

Sandra Osborne: Well before Christmas I secured a Westminster Hall debate on proposed increases to rail freight charges that threaten more than 700 jobs in my constituency. We were promised an announcement by November but nothing has come. If that means a change of heart, I very much welcome it, but may we have an indication of when an announcement will be made as the issue is causing great concern throughout the coal industry in the UK?

Andrew Lansley: I will, of course, ask the Department for Transport on the hon. Lady’s behalf whether it could let us both know the position on that issue from last year. Transport Minsters will be answering questions in the Chamber on 17 January and the hon. Lady might find an opportunity to raise the issue with them.

Pauline Latham: The Drop Inn centre in my constituency is an independently run youth organisation where young people can meet and engage in positive activities. It has assisted and continues to help hundreds of young people in Belper and is an excellent example of the big society in action. Over Christmas, the Drop Inn centre was attacked by arsonists. Will the Leader of the House find time for a debate on how we can support such big society organisations when they are victims of such crimes?

Andrew Lansley: Yes, I am glad my hon. Friend has raised that matter. It is important to support voluntary organisations, which often do not have an infrastructure that enables them to respond to such events—they should not be subject to such criminal activity. I will speak to the Parliamentary Secretary, Cabinet Office, my hon. Friend the hon. Member for Ruislip, Northwood and Pinner (Mr Hurd), who leads on support for charitable organisations, to see whether he can point to a particular measure, but generally, we have innovative routes by which we can provide not only financial support, but a great deal of practical support, to charities seeking to develop their activities.

William Bain: Will the Leader of the House give further consideration to holding a debate on how many promises the coalition has not kept, and in particular a debate on the Chancellor’s promise that he would not balance the books on the backs of the poor? He is borrowing £212 billion more than predicted, so he is certainly not balancing the books, but with 14 times more people in the poorest 10% being affected by the Welfare Benefits Up-rating Bill compared with the richest 10%, he is destroying the living standards of the poorest.

Andrew Lansley: The hon. Gentleman seems to be living in some kind of denial. We inherited the largest deficit among OECD countries and have reduced it by a quarter. We are taking the action necessary following the appalling legacy we inherited, and the way we are going about it is fair. If he looks at the distribution of impacts of income tax changes, he will see that the highest earners see the biggest increase in taxation, and that low earners see reductions in income tax, not least specifically as a consequence of the change in personal tax allowance.

Robert Halfon: Has my hon. Friend seen early-day motion 897 on restoring the 10p income tax rate that was abolished by the right hon. Member for Kirkcaldy and Cowdenbeath (Mr Brown)?
	[That this House regrets the abolition of the 10 pence rate of income tax in 2008 by the last Labour Government; notes that a starter 10 pence rate of income tax between the personal allowance and 12,000 would instantly move all British workers on the minimum wage about halfway towards earning the Living Wage, in cash terms; concludes that the poorest Brits would benefit the most as a share of income; and therefore urges the Government to restore the 10 pence rate of income tax as soon as economic growth allows.]
	May we have a debate on lower tax for lower earners? In that way, we might see how restoring the 10p rate would be a better way to help lower earners rather than recycling benefits through the tax system?

Andrew Lansley: I have seen my hon. Friend’s early-day motion. He knows we have taken action to help the lowest-paid workers, but as I have said a number of times, the increases in the personal income tax allowance will take 2.2 million of the lowest-paid out of tax altogether. Someone working full-time on the minimum wage will see their tax bill cut in half as a result of that measure.

Jonathan Ashworth: May we have a debate on the Prime Minister’s mid-term review and relaunch this week, and particularly on the full and frank audit of Government achievements? Will the Leader of the House tell us why he supposes the full and frank audit forgot to mention that the Government have trebled tuition fees to £9,000?

Andrew Lansley: Compared with previous Governments, this Government are open on the nature of our programme and what we have achieved. Our frank and full assessment demonstrates not only transparency, but a high level of achievement. On tuition fees, the hon. Gentleman must bear in mind that our policy gives this country’s universities and higher education establishments, which are a success story when compared internationally, increased resources to improve the quality of tuition.

John Glen: May we have a debate on UK Border Agency delays and bureaucracy? Odstock Medical in my constituency sponsored a PhD student for four years. Despite the change in Government policy, it was unable to secure his position in this country for a further year and he had to be sent back. That is just not good enough, and we need to sort it out.

Andrew Lansley: My hon. Friend no doubt heard my reply to my hon. Friend the Member for Hendon (Dr Offord). The chief inspector of UKBA has said that, since April 2012,
	“the Agency has ‘started to tackle the problems’, with improved governance, a stronger performance framework and a more robust approach to tracing and locating individuals.”
	Work is going on throughout UKBA, but Ministers are very aware of continuing problems of delay and the difficulty of delivering UKBA activity. All hon. Members experience that and Ministers will want to keep the House fully updated and respond fully. If Members can provide information to Ministers about the nature of the problems their constituents experience, it will help Ministers to ensure that they are delivering the changes in the UKBA that we all want.

Sharon Hodgson: May we have a debate on the distribution of funding for elite-level sports in the run-up to Rio 2016 in light of the hugely disappointing decision by UK Sport to give zero funding for sports such as basketball, table tennis and volleyball, while giving tens of millions to sports such as rowing, sailing and equestrian? Such decisions cannot just be about past success; they have to be about potential and there is huge potential for a medal in sports such as basketball, as well as it being a sport that is accessible to millions of people.

Andrew Lansley: I will, of course, raise these issues with my hon. Friends at the Department for Culture, Media and Sport, but I caution the hon. Lady that on the evidence of the Olympic and Paralympic games, UK Sport, and lottery-funded support for sport and elite sport in particular, has had tremendous success by being very clear in its determination to support the greatest potential and to focus resources to make that happen. That does not mean that we have to agree necessarily with every decision made by UK Sport, but one should give it credit for what it has achieved.

James Duddridge: May we have time for a debate on the rather bizarre decision by the Office for National Statistics not to change how the retail prices index is calculated, despite saying that how it is calculated is wrong? A change would help final salary pension schemes that are disadvantaged by legislation put in place by the previous Government.

Andrew Lansley: I do not immediately have an opportunity for a debate on this subject, but it will no doubt be discussed at Treasury questions and elsewhere soon. Of course, it was only announced this morning. For my part —I am sure the same will be true of other Ministers—we will look to the ONS to make recommendations and we will now consider them very carefully.

Diana Johnson: In light of Lord Heseltine’s report, “No Stone Unturned” and his agreement to pilot its proposals in the Humber region, is it possible to have a debate on whether local enterprise partnerships need additional powers and resources to make an impact in areas such as Hull?

Andrew Lansley: The hon. Lady will have seen that, in the autumn statement, my right hon. Friend the Chancellor gave strong support to Lord Heseltine’s report, and, in particular, for LEPs. Also, additional financial support for LEPs was announced in autumn last year. I do not have an immediate opportunity for a debate, but perhaps, through the Backbench Business Committee or elsewhere, we will see a proposal for a debate come forward. It would be useful to have a debate at an early point, not least so that the LEPs can see us understanding and recognising what they are achieving, the plans they are bringing forward, and the opportunities we want to help them realise.

Jason McCartney: When a high-profile Yorkshire business went into administration in 2011, solicitors’ fees of £15,000 and administrators agents’ fees of £14,786 were paid, yet a small graphics business in my constituency did not receive the £1,000 it was owed. May we have a debate on when local small and medium-sized enterprises, which are the lifeblood of our local economies, will be given a fair deal when they are left high and dry by companies going into administration?

Andrew Lansley: My hon. Friend makes an important point. Of course, all insolvencies involve a degree of loss, or are very likely to do so. He and other hon. Members have been pursuing prompt payment, which he knows is very important to SMEs. They should not be exposed to financing others because payments are not made on time. He will know that before Christmas we announced a review of insolvency practitioner fees, which will look to establish whether further changes are needed to ensure creditors have confidence that those fees are fair and commensurate with work done. He might also bear it in mind that the insolvency red tape challenge is in progress, which might offer another opportunity to raise this issue.

Chris Bryant: Some of us who support marriage equality none the less want to ensure that the House does a good, proper and thorough job of scrutinising the legislation when it is presented. It might
	be difficult for the Government to put together a Committee that is fully representative of Conservative Back Benchers. Would it not be a good idea, therefore, to make sure that the Bill is committed to a Committee of the whole House, or, even better, to give a few legislative days to the Backbench Business Committee, so that it could decide, almost as if it was private Members’ legislation, how to proceed?

Andrew Lansley: The hon. Gentleman will have heard my reply to previous questions. We will ensure proper scrutiny of our Bills.

Rehman Chishti: Following the tragic death of my constituent, David Young, who was stabbed on new year’s day, may we have an urgent debate on tackling knife crime?

Andrew Lansley: My hon. Friend makes an important point and mentions the tragic case of his constituent. He will be aware of the Prime Minister’s speech recently on crime and justice, when he said that the Government would be looking at toughening up knife sentences and at the use of cautions. The Home Office and the Ministry of Justice are working together to review the punishments available for carrying a knife. We strengthened sentences in relation to this under the Legal Aid, Sentencing and Punishment of Offenders Act 2012, and the Home Office has committed £18 million to support police agencies and the voluntary sector in tackling knife, gun and gang-related violence and in preventing youth crime.

Gavin Barwell: Yesterday, the Mayor of London published his draft police and crime plan, which offered Croydon an extra 117 police officers by 2015. May we have a debate on what others could learn from the Mayor of London about reducing running costs, concentrating resources on the front line and showing that, in a time of austerity, it is possible to protect front-line services?

Andrew Lansley: That is an important example for others to follow. In Cambridgeshire, I might say, we are also seeing resources being focused on the front line and an increase in police numbers. It is important to achieve that. There are good examples, and I hope that we can find opportunities when they can be set out for others to follow.

Glyn Davies: In a week when a hugely welcome new renal dialysis unit opened in Welshpool, on the Welsh side of the England-Wales border, and it was announced that Shrewsbury prison, on the English side, was to close, may I ask my right hon. Friend to programme a general debate on the implications for provision of public services that straddle the border, in the light of the advent of devolution?

Andrew Lansley: I am interested in what my hon. Friend says. On health services, in particular, I know about the sensitive border issues when it comes to accessing services between the two countries, and that needs to be got right. I will raise that matter with my hon. Friends to see whether there is an opportunity for a discussion. Otherwise, of course, it could be considered by the Welsh Grand Committee. I would just say that it is important that we get the financing right, and I encourage the Welsh Assembly Government to work with the
	Department of Health to set that financing, so that patients can exercise real choice over where they go, either side of the border, in order to access the best services.

Andrew Turner: Wightlink, the largest ferry company serving the Isle of Wight, has recently axed all overnight services on one route and reduced them on others. Although it does not affect tourism, these are lifeline services for islanders. In 2009, a market study found that the threshold to involve the Competition Commission had been reached, but it was decided not to make a referral. Will the Leader of the House arrange for a statement to be made on what alternative remedies might be available?

Andrew Lansley: I know that my hon. Friend has been in correspondence on this matter, because we have discussed it with our right hon. Friend the Secretary of State for Business, Innovation and Skills, and I know that he is also in correspondence with the Department for Transport. Without going into detail, let me say that there is no opportunity to intervene over any lack of competition in relation to these services. From the Department for Transport point of view, neither is there a case for a public service obligation. I will ask both Departments to meet him in order to discuss the service as a whole and what the Government’s relationship to it might be.

David Burrowes: I will resist the temptation to ask the Deputy Prime Minister to lead a debate on green onesies to show that we are the greenest Government ever. Instead, I would like to ask for a debate on finding a better way to determine issues of conscience, so that such Bills do not have the Government’s fingerprints all over them. If the Government are to propose such Bills, however, they should be introduced in the Queen’s Speech, as has happened for the past 12 years, up until now.

Andrew Lansley: The Queen’s Speech foreshadows legislation; it always says, among other things:
	“Other measures will be laid before you.”
	Indeed, in this Session we have introduced a number of Bills, which were desired for a number of reasons, that were not foreshadowed in the Queen’s Speech—the Growth and Infrastructure Bill, the HGV Road User Levy Bill and the Bill relating to infrastructure guarantees —and that will continue to be the case in future.

Oliver Colvile: As my right hon. Friend may know, climate change week this year is between 4 and 10 March. During the
	course of Christmas, Devon and Cornwall were badly flooded. May I ask for a debate on climate change during climate change week?

Andrew Lansley: My hon. Friend raises an important point. He and other Members might like to discuss this with the Backbench Business Committee. Debates of this character, enabling us to look at such issues, are often more suitable for Back-Bench time rather than Government time, given the way time is now structured in the House; nevertheless, I entirely understand and he quite properly raises the issue with sufficient time for it to be considered.

Jeremy Lefroy: Staffordshire university has a strong and growing partnership with Gulf college in Oman, as well as universities in Malaysia and China. May we have a debate on how to make the most of the vital partnerships between British universities and universities across the world and perhaps on how the Foreign and Commonwealth Office could be involved in that?

Andrew Lansley: My hon. Friend makes an important point. I am not aware of an opportunity in the business immediately ahead of us for a debate of that kind. However, as he made clear, when we consider the ways in which higher and, indeed, further education are responding and marketing to other countries—including, for example, the simple fact, which one would not believe if one read some of the newspapers, that the number of applications to British universities from overseas this year has increased—I think we have an opportunity to continue pushing forward the trade relationships we have. Indeed, Ministers from the Foreign and Commonwealth Office are on the Front Bench listening to this, and I know they will take this issue forward as well.

Mary Macleod: I am sure that my right hon. Friend is as concerned as I am about the health and well-being of Members of Parliament and would join me in congratulating the House of Commons on our cycle to work scheme. However, the Independent Parliamentary Standards Authority has told me that MPs are not allowed to participate in the scheme. Will he have the relevant discussions and update the House on allowing right hon. and hon. Members to participate in it?

Andrew Lansley: My hon. Friend is quite right. The technical answer is that the scheme is a salary sacrifice scheme, which under the tax rules is available between employers and employees. As Members of Parliament and their staff are not employed by IPSA, it would not be practical for it to run the scheme. IPSA does, however, operate an interest-free bicycle loan scheme and reimburses Members through expenses when they use bicycles to travel, within the rules of the scheme.

Syria

William Hague: With permission, I will make a statement to update the House on the crisis in Syria—a crisis that is still intensifying.
	Some 60,000 Syrians are now believed to have died, 600,000 people have become refugees, 2 million are internally displaced and 4 million are in desperate need. To illustrate the true horror of the conflict, 1,000 civilians were reportedly killed in one six-day period over Christmas. On Christmas day, opposition activists reported that 17 people were executed at a checkpoint in the Damascus suburbs, nine of them from one family. The regime has used Scud missiles to target populated areas and deployed cluster munitions. Entire urban districts have been reduced to rubble in cities such as Homs and Aleppo. I know that the House will join me in expressing our solidarity with millions of courageous Syrian people in the face of this appalling brutality.
	We continue to believe that the best way to end the bloodshed and to protect all Syria’s communities is through a political transition. Our country has a moral obligation to help save lives in Syria and a national interest in ensuring that the country provides no haven for terrorist activity. We know that to achieve lasting stability we must work with the Syrian opposition and countries of the region, not try to impose a political settlement from outside, and we are determined that all our actions will uphold UK and international law, and support justice and accountability for the Syrian people themselves.
	In the coming weeks we will focus on six principal areas. First, we will intensify our diplomatic efforts to reach a political transition. We are actively supporting the efforts of the UN-Arab League special representative Lakhdar Brahimi, who has travelled to Damascus, and to Moscow for talks with the Russian Government, and who is due to hold trilateral talks with Russia and the United States this week. My ministerial colleagues and I are in regular contact with him and expect to hold further talks with him in London later this month. Our goal remains to persuade Russia and China to join us in putting the full weight of the UN Security Council behind a political transition plan for Syria.
	Secondly, we will continue our work to help the Syrian National Coalition to develop its plans for the future of Syria. Since I last updated the House, I have attended the Friends of Syria meeting in Marrakesh, where the US and many other countries followed us in recognising the National Coalition as the sole legitimate representative of the Syrian people, and where $150 million was pledged to support the humanitarian effort. The coalition is enlarging its membership to include Christian, Kurdish and other minority communities. At a meeting in Istanbul this week, we saw encouraging signs of the coalition making every effort to broaden its support further and build on its legitimacy, although much work remains to be done.
	We are working to strengthen moderate political forces in Syria committed to a democratic future for the country. We have provided £7.4 million of non-lethal support to the Syrian opposition, civil society and human rights defenders, and I can now announce that
	we will provide an additional £2 million of support, bringing the total to £9.4 million. All our assistance is designed to help to save lives, to mitigate the impact of the conflict or to support the people trying to achieve a free and democratic Syria. It includes solar powered lighting, generators, communication equipment and water purification kits to help opposition groups, as well as satellite communication devices for activists to document human rights violations and abuses so that one day the perpetrators of appalling crimes can be brought to justice.
	Our assistance also involves support for local-level administration councils providing services to Syrian people during the conflict. We have given training to more than 300 Syrian journalists who are striving to develop alternative sources of media and freedom of the press in Syria, and we are training activists who are working to create a network of peace-building committees across five cities in Syria. We are also helping the National Coalition to co-ordinate the international humanitarian response, and we have provided a humanitarian adviser to work with it. At all times, we urge the coalition to ensure that all opposition groups meet their commitments on human rights.
	Thirdly, we will continue to increase the pressure on the regime to stop the violence. In December, we argued that the EU sanctions regime on Syria, including the arms embargo, should be rolled over for three months until 1 March, rather than for 12 months, so that there would be an earlier review of it. We secured that position. We believed that it was important not to freeze EU policy for a whole year just as a new opposition coalition was being launched and while the conflict was intensifying on the ground.
	No decisions have yet been made to change the support that we provide to the Syrian National Coalition or the Syrian people. However, European countries now have the flexibility to consider taking additional steps to try to save lives if there is no progress in the near future. Clearly, the best outcome for the Syrian people would be a diplomatic breakthrough, bringing an end to the bloodshed and establishing a new Syrian Government able to restore stability. However, we must keep open options to help save lives in Syria and to assist opposition groups that are opposed to extremism, if the violence continues. We should send strong signals to Assad that all options are on the table. We will therefore seek to amend the EU sanctions so that the possibility of additional assistance is not closed off.
	No one can be sure how the situation in Syria will develop in the coming months. There is no guarantee that Mr Brahimi’s efforts to mediate will be successful. President Assad’s speech last week urged the Syrian people to unite in a “war” against his opponents. Given the regime’s intransigence and brutality, there is a serious risk that the violence will indeed worsen in the coming months. If that happens, the international community’s response will have to be stepped up. So we will not rule out any options to save lives and protect civilians in the absence of a political transition in Syria. We will ensure that our efforts are legal, that they are aimed at saving life and that they support at all times the objective of achieving a political transition and encouraging moderate political forces in Syria; we will keep the House properly informed.
	Fourthly, we continue to increase our life-saving humanitarian assistance to the Syrian people. The United Kingdom is the second largest bilateral donor to UN relief efforts, supporting more than 100,000 people across the region with food parcels, blankets and warm clothing. On 21 December, my right hon. Friend the International Development Secretary announced a further £15 million in humanitarian aid, bringing our total support to £68.5 million so far. Hon. Members will have seen images of Syrian refugees struggling with rain and cold in refugee camps across the region. The latest £15 million of funding will be used to provide food, clean water, blankets and shelter to help Syrians to cope with the misery of these winter months, as well as medical supplies to treat the sick and wounded since so many Syrian medical facilities have been destroyed, and armoured vehicles to enable humanitarian agencies to deliver aid safely inside the country.
	The UN has appealed for $1.5 billion for the first six months of this year. This is the largest ever short-term UN appeal, but it remains seriously underfunded. At the donor conference hosted by Kuwait and the UN Secretary-General later this month, we will again call on other countries to pledge the additional humanitarian aid that is desperately needed.
	I pay tribute to the 26 humanitarian workers who have been killed in Syria since the fighting began, and deplore the rise in attacks on medical facilities that are contrary to international law and an affront to basic humanity. We urge all parties to stop the violence and allow humanitarian agencies to deliver assistance safely and without interference, in accordance with international law.
	Fifthly, we are continuing detailed planning for how we can help a future Syrian Government deal with the many challenges Syria will face during a transition. This process must be led by the Syrian people, but they will need help from the international community as they repair schools, roads and hospitals destroyed during the conflict, and restart their ravaged economy. Today we are hosting leading members of the Syrian opposition and representatives of 14 countries and international organisations at a Wilton Park conference designed to advance detailed planning of that support, including on political reform, security, institution building and the economy.
	Sixthly, we are supporting UN efforts to document and deter human rights abuses in Syria. The Human Rights Council’s commission of inquiry on Syria published its latest report on 20 December. It shows that the human rights violations highlighted in its previous reports are continuing unabated. We will continue to do all we can to support its work, and we are providing specific leadership in efforts to confront rape and sexual violence in Syria. We have deployed experts to the region to provide training in how to respond to reports of sexual violence and to improve the prospect of future investigation and prosecutions—and we will urgently intensify this work.
	We are also urging the Syrian National Coalition to commit itself to ensuring justice and accountability for the Syrian people, including by drawing its attention to the right of a future Government in Syria to refer
	the situation to the International Criminal Court, even though some members of the UN Security Council are blocking that option at present.
	So this is our approach: intensifying our efforts to forge agreement at the UN; pursing a political transition on the ground, while ruling out no options to save lives if the situation deteriorates; supporting the opposition and the Syrian people; increasing the pressure on the regime and being prepared to do so in new ways if necessary; working to deter human rights violations and abuses; and planning to help Syria to get back on its feet once the conflict comes to an end. The Syrian people are enduring unimaginable suffering. They are at the heart of this crisis: their future is at stake, and our country and the world must not abandon them.

Douglas Alexander: I thank the Foreign Secretary for advance sight of the statement and I am grateful to him for updating the House this morning.
	It is a matter of profound regret that the biggest single change we have seen since we last debated Syria in the House is simply the number of casualties. As the Foreign Secretary made clear, the United Nations estimated on 2 January that the war’s death toll has exceeded 60,000 of whom about half are thought to be civilians, and it predicts that the death toll will increase at a rate of 5,000 a month. The United Nations Arab League envoy Brahimi recently warned that as many as 100,000 people could die in the next year if a way cannot be found to end the country’s civil war. He described the situation as nothing less than the descent of a country into “hell”.
	The scale of the suffering is such that an effective set of actions are required, so let me turn to the four substantive points in the Foreign Secretary’s statement. First, on diplomatic efforts to reach a political transition, the continued stalemate in the UN Security Council is beyond regrettable—it is utterly deplorable. Of course the position of the Russians remains central to this impasse, but recent statements by the Russian Foreign Minister, Sergei Lavrov have suggested a possible shift of attitudes in Moscow. There is therefore a heavy responsibility not just on Lakhdar Brahimi, but on all P5 countries, including the United Kingdom, to try to break the present logjam. So does the Foreign Secretary accept that, rather than loudly condemning the Russians, a better course would be to talk to them quietly about how common ground can be established on the process of political transition in Syria? Will he tell the House when he last spoke to Foreign Minister Lavrov and when he is scheduled to speak to him next about the critical issue of Syria?
	Secondly, may I ask about support for the Syrian National Coalition? Any diplomatic support that the Government can offer to the SNC to encourage it to draw up a credible transition plan for Syria is indeed to be welcomed. In that spirit, the Opposition welcome the conference that is taking place in Wilton Park, which is doing just that, and note the additional funding that has been announced today. However, can the Foreign Secretary set out what he believes are, and remain, the principal barriers to unity which have, to date, prevented the Syrian Opposition from uniting on that credible
	transition plan? We welcomed the Geneva plan that was drawn up last summer, but does the Foreign Secretary agree that, currently, neither side of the conflict in Syria appears to be committed to implementing it? Will he tell the House whether he is still encouraging the SNC to accept the Geneva plan as a basis for transition?
	Thirdly, let me turn to the central issue in the statement, the current arms embargo and EU sanctions on Syria more generally. I note all that the Foreign Secretary said with continuing concern. May I urge him to provide more detail on the following matters? Will he set out, as far as he is able, the Government’s latest assessments of the role of al-Qaeda and other extremist organisations now operating in Syria? Given what he said in his statement, does he accept that Syria is currently awash with arms? Does he recognise the grave and continuing difficulty of guaranteeing the end use of weapons supplied to Syria, given the present uncertainty about the identity, intent and, indeed, tactics of some of the rebel forces? Does he accept that it is perfectly possible that, if Europe were to decide to arm the rebel forces, the Russians would simply increase their own supply of arms to the Assad regime? May I also ask him—not least in the light of recent comments by the Foreign Affairs Committee in an important report—what would encourage him to believe that intensifying the conflict would reduce the present appalling level of suffering of the Syrian people?
	Finally, let me turn to the humanitarian consequences of the current violence. Last October I visited the Zaatari refugee camp on the Jordanian-Syrian border, one of many such camps that have been set up to house the fast-growing number of refugees who are fleeing the violence in Syria. During my visit, the aid workers to whom I talked warned of the onset of winter and of worsening conditions on the ground. Their worst nightmares have now been realised. Only this week, aid workers in the camp were attacked by refugees after fierce desert winds and torrential rains had swept through and devastated their tents. There are warnings of a major snowstorm later this week, which will bring even deeper misery to those who are already desperate.
	The latest figures from the UN Refugee Agency show that 597,240 people have registered or are awaiting registration with the agency in Turkey, Lebanon, Jordan, Iraq and Egypt. The latest reports from the UN state that £620 million of aid is now needed to help Syrian refugees in countries around the middle east, while £312 million was required to help refugees in Jordan alone. Given the Foreign Secretary’s statement this morning that the UN appeal “remains seriously underfunded”, what steps will he and the Prime Minister take to help to secure those additional funds from the international community before the vital meeting that will take place in Kuwait later this month?
	The principal responsibility for the appalling suffering being endured by the Syrian people rests, of course, with Assad and his brutish regime. Last week, in his latest speech, he once again demonstrated a truly callous disregard for human life by expressing no real intention of helping to bring the conflict to an end or to take responsibility for its beginning. However, the burden of responsibility on the international community remains a heavy one. The Opposition believe that, rather than directing their efforts towards intensifying the conflict, the British Government should continue to focus on
	building international agreement around an inclusive post-Assad Syria and meeting immediate humanitarian needs. I ask the Foreign Secretary, not least in his capacity as a distinguished parliamentarian, to guarantee to the House that we will be consulted again before any change is made in the present approach.

William Hague: I am grateful to the right hon. Gentleman for his remarks, which illustrate that there remains a strong degree of unity on this terrible crisis across the House. I reiterate that I will continue to provide regular updates to the House; I think this is the seventh statement I have made on Syria recently. If there were to be any change in Government policy, I would, of course, bring that to the House.
	The right hon. Gentleman rightly referred to what Mr Brahimi said about the possibility of 100,000 deaths this year. That underlines the worsening nature of this crisis. It is not just a continuing crisis; it is a worsening crisis. We have to look at everything we do in the light of that. We are doing a great deal, as I set out in my statement, but we must always be open to doing more and be open to ideas for doing more. We approach this issue in that spirit.
	The right hon. Gentleman asked questions on four general areas. On the diplomatic situation, he asked, a bit pointedly, why, rather than condemning Russia, we do not talk to the Russians quietly. We do a great deal of talking to them quietly—we do that on a pretty much continuous basis—but that does not mean that we do not give our public views about their votes in the UN Security Council from time to time. I last met the Russian Foreign Minister for a substantial discussion about Syria in Dublin on 6 December, and I have invited him to visit London in the near future, so our contact with the Russians on this issue is pretty continuous. There has not been a substantial change in the Russian position, although there is, perhaps, a greater Russian interest in renewed discussions. The trilateral meeting between Mr Brahimi, the US and the Russians this week is further evidence of that. We will absolutely keep discussing the diplomatic way forward, based on the Geneva communiqué, which we did agree with the Russians. What we have never managed to agree with them is how to implement the Geneva communiqué. We see the wholehearted involvement of Russia, preferably in a UN Security Council resolution, as being required to bring that about. Russia has not changed its position on that, but we will keep working on it.
	The right hon. Gentleman asked about support for the opposition and the barriers to unity. Opposition groups have grown up almost independently of each other, and have not been able to communicate very well on the ground in Syria, and it is therefore difficult to create a united opposition, particularly when some are inside the country and others are outside the country, but the National Coalition is doing a very good job of that—in my judgment, the best job that can be done. There have been well-known difficulties at many stages in bringing in Kurdish representatives, but that has been agreed. It has been agreed that the Kurds will take up a vice-presidency of the National Coalition, but the Kurds themselves have not yet agreed who will fill that position, which serves to illustrate the difficulties involved. The National Coalition is by far the best attempt we have
	seen so far to bring together responsible opposition forces in Syria. That is why we have chosen to recognise it and work with it.
	In the right hon. Gentleman’s third set of questions he asked for more detail, but given the chaotic situation in Syria, it is not possible to quantify accurately the number of extremist, or al-Qaeda supporting, fighters in Syria. In the opinion of opposition leaders, they represent a small minority of what is perhaps a six-figure number of opposition fighters, but it is simply not possible to quantify the exact number. In light of any presence of extremists, however, it is important that we try to bring this situation to a conclusion as soon as possible and support moderate political forces. That is what much of our efforts are directed at.
	The right hon. Gentleman rightly drew attention to the many hazards in supplying arms into a conflict area. I stress that we have made no change to our policy in this regard. We are trying to build flexibility into the EU position. It is also important to note that the arms embargo as it currently stands prohibits the supply to opposition groups of such items as body armour, helmets and certain types of communications equipment, so its definition of “arms” is quite broad. That must be borne in mind in any future flexibility that we might build in.
	The right hon. Gentleman also asked, rightly, about what steps we are taking to encourage other countries to provide more humanitarian aid, as we have done. The Secretary of State for International Development and I are very busily engaged on that. I discussed it with the Arab League secretary-general, Nabil el-Araby, on Monday and I am raising it in all my bilateral meetings with European and Arab countries to try to build up, ahead of the Kuwait meeting, a greater degree of donations. I hope that I have given full answers to the right hon. Gentleman’s questions.

Malcolm Rifkind: The Foreign Secretary has said that the British Government accept a moral obligation to do what we can to save lives in Syria. Against that background, I warmly welcome his statement that the Government are now willing to “seek to amend the EU sanctions so that the possibility of additional assistance is not closed off.” Will he please confirm that that does not exclude the possibility that the Government may, at some stage, be willing to consider providing military equipment that could be used in a defensive way to save lives? He is aware—indeed he referred to the fact—that ballistic missiles had been used by the Syrian Government on several occasions this week against targets in the north. As NATO has agreed to provide and is currently deploying Patriot anti-missile batteries to protect Turkey, would it not be appropriate to consider providing similar support to Syrians, given that these anti-missile batteries cannot kill people—they can only save lives and therefore would be consistent with the objectives of Her Majesty’s Government?

William Hague: As I have said, we are not taking any options off the table; we are not excluding any option, given the worsening situation and given that no resolution to it is in sight at the moment. I also stress, as I did to the shadow Foreign Secretary, that we have not changed
	the British Government’s policy on what we will supply, but we are trying to build in the flexibility for the future. The direct answer to my right hon. and learned Friend’s question is therefore that we have not excluded that possibility; indeed, as I was pointing out in my answer to the shadow Foreign Secretary, there are many different categories of military equipment, many of which fall short of being equipment that has a lethal use. Large categories of equipment can be used to save lives and cannot be used offensively. So we have not excluded that possibility and we must keep all options open as the situation develops.

Peter Hain: Does the Foreign Secretary accept that his use of terms such as “flexibility” and leaving “all options” on the table could be a prelude to western-backed military intervention, and that that would be disastrous? The cross-party support for his condemnation of the barbarity of Assad’s regime and for political transition would disappear, because this is a civil war. This is not a barbarous dictator versus his people; it is an increasingly deepening civil war and it will not be resolved by military action.

William Hague: Let us be clear that it is a barbarous dictator oppressing his own people. I hope that the right hon. Gentleman will not feel it necessary to argue with something that I have not said; there was no mention in my statement of military intervention, nor any advocacy of that. He is setting himself up to argue with a position that the Government have not taken. [Interruption.] Yes, I am not ruling out options, but I do not think we can do so when we are facing a situation where a six-figure number of people might die this year. It would not be responsible to do that as we do not know how the situation will develop. So I am keeping our options open, but the dangers and drawbacks of military intervention are well understood in the House and in the Government.

Menzies Campbell: Notwithstanding the terrible brutality taking place in Syria, may I ask my right hon. Friend to exercise the utmost restraint and caution in any extension of policy covered by the expression “all options” are on the table? I do so, first, because this is a civil war, and intervention in civil wars has a long history of failure, and secondly, because there is a risk that we will have a proxy war between Russia and NATO fought out on the streets of Syria by Syrians.

William Hague: I am very conscious of the points made by my right hon. and learned Friend and I hope that he will agree on the position we have taken. Although we are trying to help in the mass of ways I set out in my statement, we are cautious, in the light of all the lessons of history. As I was pointing out to the right hon. Member for Neath (Mr Hain), I am not standing here advocating military intervention. So we keep our options open, but that is not some sinister disguise for a change in Government policy; if there were to be a change, I would bring it to the House.

Ann Clwyd: The Foreign Secretary has spelt it out very clearly that by the end of the year about 100,000 people might be dead in Syria. Will he
	confirm that although Security Council authorisation to use force for humanitarian purposes is now widely accepted, force can also be justified on the grounds of overwhelming humanitarian necessity without a UN Security Council resolution as long as certain criteria are met, such as that it is objectively clear that there is no practical alternative to the use of force if lives are to be saved?

William Hague: I agree with the right hon. Lady, as that is our broad understanding of international law. There is, of course, a further argument about the wisdom of such intervention, but in a situation of overwhelming humanitarian need with no clear alternative a strong legal case can be made.

Richard Ottaway: The Secretary of State has confirmed that from 1 March EU countries will have more room to manoeuvre. Does he agree that the composition of the opposition forces has now become less obvious and that their long-term intentions are less certain? Will he be very careful about who exactly he is helping before providing any extra assistance?

William Hague: Yes, of course, and we are very careful about that anyway. Part of the justification for giving the help we have given so far to the Syrian opposition is to strengthen the moderate forces and people who want to see a free and democratic Syria. Let me be clear that the flexibility I have talked about will be in place from 1 March—the whole sanctions regime on Syria has been rolled over only until then. We have not yet agreed in the EU whether or how we will amend the sanctions regime; those discussions will be going on over the next few weeks. The opportunity for flexibility has now been built in by our requesting a three-month roll-over.

Tom Clarke: I very much welcome what the Secretary of State says about Britain’s role in delivering humanitarian aid. I also welcome what he says about the European Union. On that point, and on the need to seek a political solution, will he endorse what the EU has done thus far, or does he have any other view?

William Hague: The European Union has also been engaged in trying to promote a political solution. For instance, the EU High Representative attended the Geneva talks in June. It is realistic, however, to point out that the diplomatic focus is on the permanent members of the UN Security Council and the Security Council as a whole. It is the work of nation states on the Security Council to try to settle our differences. In that respect, the EU has a more limited role, but there is a strong degree of unity across the European Union and the External Action Service strongly supports the actions we have taken.

Julian Lewis: Even though the Government are being so helpful to the Syrian opposition, have we sought to extract an undertaking from them that any store of chemical weapons discovered will be handed over for destruction so that it cannot possibly fall into the hands of al-Qaeda?

William Hague: Yes, we have very much made that point and my hon. Friend is correct to bring it up. We have made it very clear to the national coalition that we would expect any future Government of Syria to join and to adhere to the chemical weapons convention and
	the biological and toxin weapons convention. In all the conversations we have had with the national coalition, its horror of the chemical and biological weapons that all the evidence suggests have been amassed by the Assad regime is very clear. I hope that one thing that will happen in a future Syria will be the destruction and disposal of those weapons.

Mike Gapes: The United States has said that there is a red line if the Assad regime uses chemical weapons, but when the Foreign Secretary meets the Secretary of State designate, Senator John Kerry, as I think he will shortly, will he impress on the US that red lines should relate not just to chemical weapon use, but to the other crimes being carried out by the Assad regime?

William Hague: Yes. Our horror at the prospect of the use of chemical weapons should in no way mitigate or minimise our horror at the brutality across the board of the Assad regime. The United States has so far adopted very similar policies to the ones I set out to the House and is also engaged in the humanitarian relief and the provision of similar types of equipment to the Syrian Opposition. Of course I will discuss this in great detail with Senator Kerry over the coming weeks. Nevertheless, it was quite right that the United States—and we joined them in this—sent a particularly strong message to the regime about the use of chemical weapons. It may be that the communication of such a strong message helped to inhibit the use for now of such weapons, so it is right that we send a particularly powerful message on that.

David Burrowes: With your generosity, Mr Speaker, and that of the Foreign Secretary, may I ask that we ensure that the resolve not to abandon the civilians on the borders of Syria is matched by similar resolve in respect of civilians on the borders of another country, Burma? I have just received an e-mail from a source in Kachin state that says:
	“Five or six fighter jets and helicopter gunships are attacking the areas around Laiza every day. . . IDPs and innocent civilians are terrified . . . they have totally destroyed the peace building process.”

William Hague: Thank you, Mr Speaker, for allowing us to go a little wide of the situation in Syria—thousands of miles away. Of course we are deeply concerned about continuing conflicts in Burma, which are at the top of the list of what we raise with the Burmese Government; the Minister of State, my right hon. Friend the Member for East Devon (Mr Swire), who is sitting next to me, was there recently having those discussions. I will look at the report that my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) brings up and we will continue to communicate our views very clearly to the Burmese Government.

David Hanson: There is a strong Syrian diaspora in the United Kingdom, including in my constituency. What assessment has the Foreign Secretary made of the number of refugees who may want to see Britain as their ultimate destination, and what discussions is he having with his right hon. Friend the Home Secretary to ensure a sympathetic response to any requests?

William Hague: The emphasis is very much on helping to look after refugees where they have arrived, as they clearly have in vast numbers on the borders of Lebanon,
	Jordan, Turkey and Iraq, and some of them are now in Egypt. I cannot give the right hon. Gentleman any guarantee about any individuals or any particular number that would be able to come to the United Kingdom, but of course as the situation continues to deteriorate and the numbers continue to mount we will have to keep that under review.

Bob Stewart: In view of the absence of unanimity among the permanent members of the Security Council, as a result of which instructions to the International Criminal Court are hamstrung, does my right hon. Friend agree that it is a key responsibility of whatever regime follows in Syria to indict alleged war criminals and bring them to trial, rather than pass them to the International Criminal Court?

William Hague: A future Syrian Government can do either, as has been the position in Libya. It will be open to them to refer the situation in their own country to the International Criminal Court. It will also be open to them to pursue justice in their own country. We would express the hope that if they do that, they will act in line with international norms and human rights standards, but they can do either. It is up to them to decide in the future.

Keith Vaz: Of the 600,000 refugees who fled Syria, 200,000 have ended up in Turkey. Given that last year 100,000 people crossed the border between Turkey and Greece, what specific help is being given to those two countries to deal with the problem?

William Hague: Officially, the latest figure for Turkey is 150,000, but there will be other people who are not caught by the official figures, so it is on an enormous scale. Turkey receives some of the assistance I have described. Our assistance is delivered primarily through international humanitarian agencies, which are working in all countries concerned, so it goes through that form. That includes Turkey, as it asked for international assistance. I am not aware of Greece asking for particular assistance. In many such cases people go to live with families, rather than in camps. Wherever assistance is needed, that of course is what the money we are providing is for.

Martin Horwood: I strongly welcome the approach of cautious flexibility that the Foreign Secretary has set out but, in the interests of a peaceful and diplomatic outcome to the conflict, are we encouraging or facilitating any communications between the Syrian National Coalition and Russia, perhaps with a view to reassuring the Russians about any future security concerns that might be preventing them playing a more responsible part in resolving the conflict?

William Hague: I am grateful to my hon. Friend for welcoming the cautious flexibility, or the flexible caution, whichever he said—either could be applied. We are in favour of all concerned discussing these matters with each other. There has been a growing reluctance among Syrian opposition groups to discuss things with Russia because they are so appalled by its policy towards Syria, but we absolutely encourage discussions between the National Coalition and the Russian Government. That
	ought to reassure Russia, but no such discussions with the opposition over the past 23 months, since the crisis began, have yet produced any change in the Russian position.

Angus Robertson: I thank the Foreign Secretary for his statement and for advance sight of it. In it, he stressed support for “the flexibility to consider taking additional steps to try to save lives if there is no progress in the near future.” Given the concerns we have heard about the potential for military intervention, can he be absolutely clear about what those additional steps might be?

William Hague: The broad answer is no, because the flexibility is designed to allow us to take a variety of steps in future, and we have not decided on any of them. The reason I stress that and make it clear to the House is that we secured a change in the duration of the EU sanctions regime when it came up for renewal in December. It was due to be renewed for 12 months, but we and France, in particular, argued that it should be renewed for only three months so that we can reconsider our policies at that stage. That was to provide flexibility, not because we have changed what we have decided to do. I pointed out in response to earlier questions that the arms embargo of course covers weapons that would have lethal effect, but it also covers body armour, helmets and certain types of communication equipment, so it is easy to see that there might be a case for greater flexibility.

Crispin Blunt: The Foreign Secretary has committed us to continued assistance for those opposition groups opposed to extremism. Plainly, there are opposition groups, both within the coalition and operating on the ground, that we have difficulty with because of their vision for Syria’s future. Will he share with the House his assessment of the balance of power within opposition forces between those whose vision for the future we would welcome and those whose vision we would be uncomfortable with?

William Hague: As I have mentioned, it is impossible from outside Syria, or even from inside, to quantify that balance precisely. It is the contention of leading figures in the National Coalition that the great majority of those taking part in the fighting, and those opposing the Assad regime peacefully, want a free future for their country and their people, want rid of the regime and do not have an ideological or religious fundamental agenda. Certainly, acquaintance with the leading figures of the National Coalition corroborates that view. Their sincere contention is to bring about a free and democratic Syria. The longer the conflict goes on, the greater the opportunity for extremist groups to establish themselves. I do not want to offer any quantification of that, but the balance of opinion among opposition forces is still, thankfully, on what we would call the moderate side.

Hugh Bayley: I hope that the Patriot missiles and the American, Dutch and German troops operating them will deter further attacks and incursions from Syria into Turkey. Will the Foreign Secretary explain to the House under whose command the missiles are and in what circumstances an order could be given to use them?

William Hague: The missiles are positioned in Turkey back from the border and are there to protect Turkish airspace. They are clearly not part of any intervention in Syria. They are not designed to do that and will not be positioned to do that. They are NATO equipment, so of course all the arrangements follow logically from that. It is a NATO deployment.

Philip Hollobone: With a population of 4 million, Lebanon is a small but very important neighbour to Syria, which has a population of 22 million. Lebanon is struggling to cope with the 200,000 refugees who have crossed its border. Is the Foreign Secretary on red alert, or amber alert, for the spread of the civil war across the border into Lebanon, and what humanitarian assistance can we offer its Government?

William Hague: We are very much on alert and active in assisting Lebanon. Over recent months our ambassador there has done an excellent job in supporting political stability on the ground in difficult circumstances. Of course, part of our humanitarian aid goes to Lebanon and we are ready to increase it if necessary. We have also doubled our assistance to the Lebanese armed forces to help them cope with this difficult situation.

Louise Ellman: There are reports that at the end of November the findings of Israeli intelligence led the United States, Russia and China to put pressure on President Assad to cease his programme of arming missiles with chemical weapons. Does the Foreign Secretary think that programme will resume?

William Hague: The hon. Lady knows that I cannot comment on intelligence matters in the House, but I can say that at the end of November the United States did issue the warning we discussed earlier, and indeed I brought it up in the House as well. As I made clear at the time, we had a reason to do that and to give a specific warning against the use of chemical weapons. I know that, due to the history in relation to Iraq, whenever Governments assert that there is no doubt about the existence of chemical or other weapons, people are entitled to their scepticism, but there can be no doubt about the existence of such weapons in Syria or that the Assad regime has deliberately manufactured and stockpiled large quantities of such weapons. If there was any chance that the Assad regime would survive in future, I am sure that it would continue that manufacturing and stockpiling.

Andrew Stephenson: The Foreign Secretary rightly talks about chemical and biological weapons and will be aware how fearful the Syrian people are that the Assad regime could use those weapons against them. Is there currently any assistance the UK could provide to Syrian groups to detect or guard against the use of chemical or biological weapons?

William Hague: That is a good point, and it illustrates one of the complexities of the EU arms embargo. We are currently unable to supply chemical detection equipment to opposition groups in Syria because of the terms of the embargo. That is a good illustration of an area where flexibility might be needed in future.

Rushanara Ali: I have a constituent whose wife and children are stuck in Damascus and unable to get out due to the dangers. What help can the Foreign Office give to help them get out? That raises the wider question of humanitarian access and medical aid to people inside Syria who are stuck in the conflict. What progress is being made to help people inside the country?

William Hague: Progress has been made in some areas, but probably more than half the 4 million people in desperate need cannot currently be reached with humanitarian or medical assistance. That is why I reiterated the appeal to all concerned in Syria to allow peaceful humanitarian access. This is a major aspect of the crisis. Of course, there is nothing directly that we can do to change that other than to work with the agencies and the National Coalition and to call on the regime to allow such access.
	On the hon. Lady’s point about her constituents, I will have a look at the specific case if she would like to give me the details. However, it is quite a long time now—about a year and a half ago—since we asked all British nationals to leave Syria. Our embassy had to be closed for safety reasons a long time ago. The Hungarians then very generously took over our consular responsibilities, but they have had to close for safety reasons as well. She can therefore understand that our ability to assist people on the ground in Damascus is now virtually non-existent.

Andrew Turner: What steps is my right hon. Friend taking to ensure that the minority Christians, many of whom have given their acquiescence to the Government, will not face persecution if Assad’s regime were to fall in whole or in part?

William Hague: I am glad to say that Christian activists have joined in the opposition National Coalition. We stress at all times to the National Coalition the importance of not only maintaining the inclusion of Christian, Kurdish and other minority communities but constantly reiterating its commitment to a country where in future all those people have their rights acknowledged and can prosper and live together peacefully. That is very much the declared intention of the National Coalition, and we must hold it to it in future years.

Paul Flynn: Will the Foreign Secretary give an absolute guarantee that prior to the commitment of any UK troops there will be a debate and a vote in this House on the lines of the precedent of 2003? He has said that he believes in the UK punching above our weight. Does not that often mean spending beyond our interests and dying beyond our responsibilities?

William Hague: I say no to the second part of the question—I do not believe that it means that. It means many things. It means our country having a presence and an activity in the world of which our 260 diplomatic posts and our huge development programme are good examples. I hope that the hon. Gentleman is in favour of those things, which are aspects of our punching above our weight in the world.
	On the commitment of forces, I stress again that I have not said anything today, or in any statement, advocating the commitment of UK forces. In any circumstances, in Syria or elsewhere, we now have a
	well-established convention in this House of which I personally am a strong advocate and in which the Government as a whole believe very strongly. So yes, the hon. Gentleman can have a broad assurance about that.

Robert Halfon: Given the stockpiles of chemical and biological weapons, given that their use would affect not only Syria but the neighbouring countries, and given that the regime, which it appears is about to fall, is more likely to use those weapons, does my right hon. Friend agree that it would be right in that circumstance for NATO to take preventive action under the responsibility to protect?

William Hague: It is right for us to have contingency plans. It is very difficult to lay down in advance what we would do in every situation, but we have sent a very strong warning to the regime about chemical weapons. The United States has led that warning. I cannot go into the details of the military contingency plans that we or NATO have to deal with a wide variety of situations, but I can assure my hon. Friend that our contingency plans do deal with a wide variety of situations.

Luciana Berger: I listened carefully to the Foreign Secretary, specifically to what he said about the UK’s relief efforts with regard to the 100,000 people to whom we are giving food parcels. He will know that the UN is warning that it can reach only 1.5 million of the estimated 2.5 million Syrians in need of food aid. What conversations has he had with leaders of the surrounding Arab countries to help UN agencies to get improved access to those in need of assistance?

William Hague: We have many such conversations; for instance, I discussed it with the Foreign Minister of Jordan yesterday afternoon. The problem is not about the willingness of the neighbouring Arab countries. We should pay tribute to them, because they very generously bear a great burden having welcomed into their countries hundreds of thousands of people. There are many people not only in the camps but staying in families and communities in Jordan, Lebanon, Iraq and Turkey. I absolutely pay tribute to those countries. They are not the problem; the problem is the attitude of the Assad regime, whose forces do not permit humanitarian access to large parts of the country, and the fighting in many other areas that makes it hard to get access. That is one reason why, as I said, we are providing funding for armoured vehicles that can carry humanitarian assistance into certain areas so that aid workers can provide it with a greater degree of safety. We have to keep working on this with the National Coalition, keep the international pressure on the regime, and encourage countries globally to provide the necessary funding.

Duncan Hames: Returning to the UN situation, when I spoke about Syria to China’s ambassador in London yesterday, he reiterated his country’s opposition to imposing regime change. Does the Foreign Secretary agree that it will be harder for Russia and China to establish good relations with the Syrian people and their next Government the longer they stand in the way of hastening an end to their painful struggle?

William Hague: Yes, I very much agree with that. There is a diplomatic price in Syria and in the region for Russia and China in blocking, as they have, what we have tried to do at the UN Security Council. What we are calling for at the UN is not regime change but a transitional Government who can include members of the current regime and members of the opposition on the basis of mutual consent; of course, we understand that not to mean Assad and his immediate acolytes. China and Russia have agreed to that in our Geneva discussions, but they have never agreed to the UN Security Council putting its full weight behind a chapter VII resolution with the threat of consequences to bring it about. That is the leap that they have not been willing to make. I encourage all hon. Members to point out these things to diplomats of those countries, as the hon. Gentleman has been doing.

Diana Johnson: In previous statements the Foreign Secretary has identified specific money for work to do with sexual violence and the victims of sexual violence. In today’s statement, he said that we will intensify this work as a matter of urgency. Are further resources and funding going into that particular piece of work?

William Hague: Yes, they are. We have done specific work on this on the borders of Jordan. I have now assembled a team of 70 experts to work globally on an initiative to prevent sexual violence, including doctors, lawyers, people skilled in documenting such abuses, psychologists and so on. Last month we deployed part of the team to the Syrian borders; I did not announce their location for their own safety. There will be further such deployments of British experts. Following that first trial deployment, I expect to be able to deploy them further in the region in the coming months.

Jason McCartney: Will the Foreign Secretary tell me whether the United Kingdom is able to supply body armour, not necessarily to the armed groups but to the innocent Syrian civilians who are being caught in the crossfire?

William Hague: This is another very relevant point in our discussions about the arms embargo. We are not able to supply body armour at the moment. We supply the equipment that I set out in the statement, but body armour is another item that is caught by most definitions of the arms embargo as it stands. When we talk about flexibility in future, we have to bear it in mind that an arms embargo on the opposition covers equipment of this nature as well as lethal equipment.

Mark Lazarowicz: Given what the Secretary of State has said about the difficulty of getting emergency aid to the millions who need it, should not the UK Government and the world community give a high priority to putting pressure on all those who have influence over parties in the Syrian conflict to allow that humanitarian aid to access places in need? Russia is an obvious example, but we also have influence and we should use it in this conflict.

William Hague: Yes, absolutely. We are constantly trying to do that and that includes the pressure that we put on Russia. A major point is that the Friends of Syria—more than 100 countries—have taken up trying to put that pressure together, but on this subject, as on so many others, no amount of international pressure has succeeded in changing the brutal attitude of the Assad regime, which sees any international presence as a threat to it, even when it is an international effort to deliver humanitarian aid.

Bob Blackman: Clearly, the Assad regime is dependent on Russian and Chinese diplomatic support, but what assessment has my right hon. Friend made of the possible logistical support and weapon rearmament provided by Iran to the Assad regime? If that is the case, what can be done to sever that link?

William Hague: There is a good deal of overwhelming evidence, as I have said in the House previously, of the tangible assistance given by Iran to the regime. It is another aspect of the deeply unhelpful policies pursued by Iran in the region. That assistance is likely to have included, in recent times, financial assistance to the regime, but also people to assist in the conflict itself and military equipment. We do everything we can to inhibit the supply of such equipment. I have taken up several times with the Iraqi Government the issue of the overfly over Iraq of Iranian flights into Syria. The Iraqi Government have given assurances about that and, indeed, have searched some flights in recent months. We will continue to take up that issue with Iraq and, indeed, try to expose Iran’s participation in the brutal oppression of the Syrian people.

Thomas Docherty: The Foreign Secretary, as a former historian, has already alluded to the need to learn the lessons of history. May I press him a little more on what steps the Government are taking to make sure that the lessons from Libya for transition to the future are learned in Syria?

William Hague: Yes, we must learn those lessons. The situations are, of course, different. We must always respect the differences between these countries. The more that the national coalition can create a consensus among opposition groups about the basis, philosophy and principles on which they would like to see the country governed, the more successful Syria will be in future. That is more important than deciding which individuals will occupy which posts. It is important that they are in contact with and have influence over as many as possible of the armed groups and militias that support the opposition cause, because in Libya different groups fighting in different parts of the country did not have strong enough links for the subsequent government of the country.

Rehman Chishti: The Secretary of State will be aware of reports that President Assad has offered to exchange 2,000 captured opposition personnel in return for 43 Iranian military experts and that Iran has also given him missiles. In light of this imbalance of resources, what further support can the United Kingdom and other international partners give to the opposition?

William Hague: That relates to all the issues that we have been addressing over the past hour. We are giving the further, non-lethal practical support that I mentioned in my statement and we are trying to secure within the EU the flexibility to change or develop that as the situation changes in the future, for the reasons I have given. My hon. Friend the Member for Pendle (Andrew Stephenson) brought up the very good example of chemical detection equipment. We will have to look at those things if the situation continues to worsen.
	We have all seen the reports of an exchange, and my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) is right to bring that up. The fact that there are such large numbers of Iranian military experts in Syria whose release the Iranians have had to negotiate illustrates the point we have just been making about Iran’s involvement.

Jonathan Ashworth: I welcome the Foreign Secretary’s commitment to continue to speak to his international counterparts about the humanitarian assistance needed. Given that this terrible situation will only get worse because of the first winter storms hitting many of the refugee camps in Lebanon, Jordan and elsewhere, will he undertake to speak to his international counterparts with a degree of urgency? The Foreign Secretary has also said that we are the second largest donor to the UN programmes at present. Does that suggest that richer countries are not putting in as much as they should, and is he confident that the UN target will be met?

William Hague: The hon. Gentleman is right that there is urgency to this matter. As I have mentioned, we are already speaking—we have been doing so for some time—to other countries about the need to supply more financial assistance to the humanitarian agencies involved, and the United Kingdom succeeds in setting a very good example. That is part of our daily discussions with other nations from all parts of the world. It is not possible to say, given the scale of the appeal for $1.5 billion and the world’s poor track record so far in meeting it, that we are confident that it will be met, but there will be an intense effort over the coming weeks. My right hon. Friend the International Development Secretary is heavily engaged in it and the hon. Gentleman can be assured that we will not waste any opportunity to encourage other countries to play their part.

Events in Northern Ireland

Theresa Villiers: With permission, Mr Speaker, I would like to make a statement about recent events in Northern Ireland.
	Before updating the House on the protests and disorder, I wish to report on a serious attempted terrorist attack. On 30 December an officer of the Police Service of Northern Ireland discovered an improvised explosive device attached to the underneath of his car shortly before he was due to drive his wife and family to Sunday lunch. The IED was viable and were it not for the alertness of the officer in checking his car, it is highly likely that he and his family would all have lost their lives.
	This despicable attack bears the hallmarks of the so-called dissident republicans and looks to be the latest example of the relentless attempts of these groupings to try to murder police officers. It underlines the need for continued vigilance and the Government will continue to do everything they can to help the PSNI combat the terrorist threat in Northern Ireland.
	The House should also be aware that two individuals have been charged in relation to the murder of Prison Officer David Black.
	Turning to the disturbances in Belfast and other parts of Northern Ireland, since I last reported to the House on 11 December protests over the flying of the Union flag at Belfast city hall have continued, with only sporadic respite over Christmas. Although many of these protests have been peaceful, even they have seen roads blocked and daily life disrupted. A significant number of protests have led to serious disorder, mainly concentrated in east Belfast.
	Although, thankfully, there were no significant public order incidents last night, the violence during the preceding six days saw masonry, bricks, fireworks and petrol bombs thrown at police, and in once instance shots were fired. Police vehicles have been attacked with sledge hammers and, in total, 66 police officers have been injured since the protests first began. On 5 and 7 January, water cannon and AEP rounds—attenuating energy projectiles—were discharged. Threats and intimidation against elected representatives continue, with the office of the hon. Member for Belfast East (Naomi Long) still the subject of daily intimidation.
	The intimidation and violence is unacceptable and intolerable. The Government condemn those responsible in the strongest possible terms. We reiterate our full support for the Chief Constable and his officers in their courageous attempts to maintain law and order. I take this opportunity to pay tribute to the bravery and professionalism of PSNI officers, who put their personal safety on the line every day to keep people in Northern Ireland safe and secure.
	According to the Chief Constable, senior individual members of the Ulster Volunteer Force are involved in orchestrating the violence, although in his view this is not being sanctioned by the leadership of the group.
	Since 3 December, 107 people have been arrested and 82 charged with various offences. The perpetrators of this violence should be in no doubt that, as the Chief Constable made clear on Monday, they will face the full
	rigour of the law. Those who continue to organise these protests and engage in violence need to ask themselves what they think they are achieving. The idea that hurling bricks at police officers is somehow defending the Union flag or protecting Britishness is incomprehensible. These people are not defending our national flag; they are a dishonouring our national flag and our country. What is more, they are being reckless with the peace process and all that it has delivered.
	The damage that those people are inflicting on Northern Ireland’s economy must be considerable. Huge efforts have been made in recent years to project a modern, confident, outward-looking Northern Ireland that is a great place to do business. However, the pictures of riots and disorder that are being beamed around the world make it far harder to compete in the global race for inward investment. Jobs and livelihoods are under threat. It is therefore essential that the protests and violence stop now.
	Since the disturbances began, I have been in regular contact with the Chief Constable, the First and Deputy First Ministers, the Justice Minister and other political leaders. The Northern Ireland political parties need to work together to find a way forward. It should not be impossible to find a solution which sees decisions on flags made in a way that respects different views and takes into account the different traditions and identities present in today’s Northern Ireland. For that to happen, the issue needs to come off the streets to allow local politicians and community leaders the space to sit round a table and engage in constructive dialogue.
	I have used recent weeks to highlight the urgent need to make progress in addressing the underlying divisions within the community in Northern Ireland, which can make decisions on issues such as flags so fraught with tension. On many occasions, Northern Ireland’s political leaders have expressed their firm commitment to building a shared society, free from sectarian division. That is a theme to which I and my predecessor, along with the Prime Minister, have returned many times.
	So much has been achieved in the 20 years since the peace process really got under way. The overwhelming majority of people in Northern Ireland can lead their lives with a normality and freedom from fear that would have been impossible back in the dark days of the troubles. However, we all need to acknowledge that the process is not finished, and the stability delivered by the Belfast agreement should never be taken for granted.
	For some, sectarian divisions remain deeply entrenched and it is time for bold moves by Northern Ireland’s political leadership to address them. We need to build a genuinely shared future for everyone in Northern Ireland. It will not be easy, but Northern Ireland’s political leaders have already shown themselves capable of taking difficult decisions in order to make progress on many matters. They have fixed tougher problems than the ones that we face today. I believe that they can rise to this challenge as they have to so many others over the past two decades. The UK Government stands ready to work with them and support their efforts to deliver a better and more cohesive future for Northern Ireland.

Vernon Coaker: I thank the Secretary of State for her statement and for advance sight of it. I join her in condemning the disgraceful violence that
	we have seen over the past weeks. The serious rioting, attacks on the police and threats against elected representatives, including the hon. Member for Belfast East (Naomi Long), have been appalling. As the Secretary of State has said, the hon. Lady has behaved throughout with dignity and courage.
	This violence would not be acceptable in London, Cardiff or Edinburgh, and it is not acceptable in Belfast. People in Northern Ireland need to know that the UK Government are giving this matter the highest priority and that Northern Ireland matters. May I therefore ask the Secretary of State what discussions she has had with the Prime Minister about the recent violence and what discussions he has had or intends to have with Northern Ireland Ministers about what might be done to support them further?
	It was welcome that the Secretary of State updated the House on the attempt by dissident republican terrorists to murder a police officer and his family over Christmas, which was sickening. As she said, that reminds us of the ongoing threat from those who wish to destroy the peace and progress. It is good that the police have made arrests in relation to David Black’s murder. That sends out the clear message that the perpetrators of these crimes will be brought to justice wherever possible.
	The public disorder and violence that we have seen on the streets began when the decision was taken by Belfast city council that the Union flag should be flown only on designated days. Will the Secretary of State join me in saying that in a democracy, one cannot try to change decisions by the use of force, and that those who break the law can expect to be dealt with using the full force of the law? Violence can never be allowed to win.
	As the Secretary of State said, the Police Service of Northern Ireland has shown exceptional bravery and courage, even at great personal cost, with 66 officers having been injured already. Let us all follow her in commending the police for their professionalism and dedication to duty.
	The Chief Constable has stated clearly that senior figures from the Ulster Volunteer Force are involved in much of the violence. What assessment has the Secretary of State made of loyalist paramilitary involvement in the disturbances? Does she agree that attacks by paramilitaries on the police and elected politicians are matters of national security? Is she confident that the PSNI has the resources to continue its current level of commitment without impacting on its other policing duties?
	Today, I was due to visit a project in Belfast that helps young people back to work. I have seen in communities across Northern Ireland, both nationalist and Unionist, initiatives to ensure that every young person has hope, that every community looks to the future, that jobs are created and that everything possible is done to overcome the sectarianism and divisions of the past. The responsibility for much of that is devolved, but will the Secretary of State ensure that the consequences of all her Government’s economic and social policies are fully considered with respect to Northern Ireland? Deprivation, disengagement and alienation are a challenge in any community, but if that challenge is not met in Northern Ireland, it can have dangerous consequences. As the Secretary of State said, we need to ensure that Britishness and Irishness are fully respected in Northern Ireland.
	Will the Secretary of State join me in saying that the scenes that we have seen on the TV do not represent the real Northern Ireland, and that we must do all that we can to ensure that positive messages about the new Northern Ireland are seen and heard across the world? There has been real progress over recent years in Northern Ireland. It is not easy and sometimes there will be setbacks. As I have said, we need to deal with the alienation that we see in some of the communities of Northern Ireland, and particularly in some of the most deprived communities. However, the setbacks must not be allowed to define Northern Ireland and its people or to derail the progress that has been made. Too much has been achieved for that and we must not allow the clock to be turned back.

Theresa Villiers: If you will forgive me, Mr Speaker, I will answer at some length, given the number of important matters that have been raised.
	Like the shadow Secretary of State, I pay tribute to the courage and dignity of the hon. Member for Belfast East (Naomi Long). It is intolerable that she and so many other elected representatives from Northern Ireland have been subject to death threats and intimidation.
	I welcome, once again, the constructive and bipartisan tone of the Opposition on the matters that we are discussing. I wholeheartedly agree with the shadow Secretary of State that such violence is not acceptable on the streets of the United Kingdom, whether in Edinburgh, London, Cardiff, Manchester or Belfast. It is intolerable and deeply damaging.
	The shadow Secretary of State asked for assurances about contacts with the Prime Minister. The Prime Minister is being briefed every day and I have had three face-to-face meetings with him on this matter, including one this morning. I am keeping in regular touch with him. He retains a close personal interest in Northern Ireland because he knows what a great place it is and what huge opportunities it has. That is one reason why it was his personal decision to take the G8 to Northern Ireland later this year. He is keeping a very close eye on all that is going on. I should also mention that I have briefed the Irish Government on these serious matters.
	Like the shadow Secretary of State I think that although the headlines focus on the disorder, we should never forget that the ongoing terrorist threat is very serious. One risk associated with such disorder is that police officers are brought into vulnerable situations where they might become targets for dissident republican attacks. I also agree with the shadow Secretary of State that democratic decisions cannot be changed by violence. The history of Northern Ireland over the past 50 years demonstrates that it is sitting round a table, talking, engaging in a dialogue, and considering compromises and an inclusive way to resolve issues that lead to progress, rather than resorting to violence and rioting.
	The shadow Secretary of State mentioned the role of the UVF, which we have discussed on a number of occasions. I have also discussed the issue with the Chief Constable and other PSNI officers. It is of concern that individual loyalist paramilitaries are involved in these matters, and crucial that the police do all they can to ensure the full rigour of the law is brought to bear on anyone engaging in violent conflicts, whether or not they are members of paramilitary organisations. As I
	have said, the Chief Constable’s view is that the orchestration is not coming from the leadership of the UVF, and that is consistent with my view.
	Whether these issues raise matters of national security is a point I discussed with the Chief Constable and Drew Harris yesterday afternoon. In essence, there is always an overlap at the border between matters of national security and other areas of policing, but I assure the House that the PSNI and its partner agencies such as the Security Service are doing all they can to combat that threat. They are certainly not letting the borderline between national security and other matters get in the way of an effective response. However these incidents are categorised or classified, it is vital that the police bring to bear every means available to combat these disgraceful scenes of violence. On PSNI resources, the Chief Constable is confident that he has the capacity to deal with the disorder, but having resources tied up dealing with these riots leaves fewer resources for the community policing that is so important for confidence building and protecting people from crime.
	Like the shadow Secretary of State I welcome the positive initiatives under way in Northern Ireland to give young people hope, and I reassure him that all the Government’s economic policies are thoroughly tested for their impact on low-income and disadvantaged communities. The reality is that it becomes much more difficult to fix the kinds of problems that may concern those involved in these protests—educational under- achievement, health care, jobs—if there is rioting on the streets. It is counter-productive for protesters to engage in violence; they are doing no service to the causes they espouse but instead making it more difficult for the Northern Ireland Executive to deliver a safe and prosperous Northern Ireland.
	Like the shadow Secretary of State I believe that a key part of the Belfast agreement is that both Britishness and Irishness are fully respected as different identities in Northern Ireland. The success of the past 20 years demonstrates that those who define themselves as British and those who define themselves as Irish can co-exist peacefully in Northern Ireland and work constructively together.
	Finally, I welcome the opportunity to emphasise the positive about Northern Ireland, and whatever has happened over the past six weeks should not blind us to the fact that it is a great place in which to live and invest. It could be a fantastic year for Northern Ireland with Derry/Londonderry already taking its place as a successful UK city of culture, the G8, and the world police and fire games—one of the biggest international sporting events in the world. All those things are an opportunity to project a modern, forward-looking Northern Ireland. We need to get back to that because the protests are undermining what could be a fantastic year for Northern Ireland.

Laurence Robertson: I thank the Secretary of State for early sight of her statement and for keeping me, as Chairman of the Northern Ireland Affairs Committee, informed about what has been going on in Northern Ireland. I also join her in paying tribute to the dedication and bravery of the
	PSNI which, along with its predecessor the Royal Ulster Constabulary, has saved Northern Ireland from sinking into even deeper problems over many years.
	We have heard it said that certain people in Northern Ireland have not reaped the benefits of the peace process. Although I agree there is a lot of work to do in that respect, does the Secretary of State agree that the underperformance of the economy in Northern Ireland is largely a result of violence over many years, the likes of which we have again witnessed over the past few weeks? Is not the way forward, as she has said, for both communities to sit round the table and discuss these matters, rather than carrying out terrible acts such as the murder of prison officers and the attempted murder of police officers?

Theresa Villiers: I very much agree with the Chairman of the Northern Ireland Affairs Committee. Many of the economic difficulties in Northern Ireland have their roots in the violence of the past. That is why it is so frustrating that rioting and violence today is undermining what have been incredibly successful efforts by the First and Deputy First Minister to attract inward investment. If any of the rioters are concerned about prosperity and jobs, going out on the streets and hurling bricks at police officers is the last thing that will improve that situation. Such behaviour is guaranteed to deter investors from coming and creating jobs.

Peter Hain: I say to the Secretary of State that condemning the deplorable violence is the easy bit, and will she do two further things? First, given her national security responsibilities will she engage directly with the loyalist groups and be willing to talk even to those who may be on the fringes of the violence—as we did to positive effect in 2006-07—who feel excluded from the political process? Secondly, will she come up with a package of resources to tackle the deplorable level of youth unemployment? Some of the young republicans—and in recent times the young loyalists—involved in this violent activity have no stake in the society. That does not justify their violence but it does explain why it is happening.

Theresa Villiers: I certainly think that part of the way forward is an inclusive dialogue that must be led by Northern Ireland’s political parties. Indeed, as part of our work I and the Minister of State engage in regular conversations and listen to the concerns of people across the community. Addressing youth unemployment is one of the UK Government’s highest priorities. Employment figures across the UK have been improving over recent weeks but there is still a very significant problem, particularly in Northern Ireland. The issue continues to be one of our highest priorities and we will continue to work with the Northern Ireland Executive on ways to grapple with it. One reason David Cameron chose to bring the G8 to Northern Ireland was to demonstrate his commitment and attract inward investment.

Mr Speaker: I know the Secretary of State was referring to the Prime Minister. We are clear.

Andrew Rosindell: The whole House agrees that the violence and intimidation taking place in Northern Ireland is totally counter-productive and undermines the very cause the protesters are protesting
	about. Does the Secretary of State agree with me that it is right that the flag of the United Kingdom of Great Britain and Northern Ireland should fly above city halls, town halls and all municipal buildings throughout the United Kingdom, as it does above the British Parliament?

Theresa Villiers: I agree that these violent protests are counter-productive and that those engaged in violence are undermining the cause they wish to support. It is important that decisions on flags are taken in an inclusive way with respect for different perspectives and points of view. Arguably, there is no one-size-fits-all solution, which is why I have been encouraging the leadership of the political parties to come together and engage in dialogue on the right solution for flags and symbols in Northern Ireland.

Jeffrey M Donaldson: I am proud to be British and proud of our Union flag but the violence in Northern Ireland, whether from loyalists or dissident republicans, grieves me greatly. We have been unequivocal in our condemnation of all such violence and of attacks or threats against elected representatives. Before Christmas, I, my wife and my children were threatened with being shot because of the stand that I take in Northern Ireland. This House will stand with all Members from Northern Ireland who continue to uphold the standards and principles of democracy.
	I echo the comments of the right hon. Member for Neath (Mr Hain): we need more than condemnation. The Good Friday agreement and the St Andrews agreement were about developing consensus politics in Northern Ireland. With respect, the decision of Belfast city council to remove the Union flag was not about consensus politics; in fact, it was a reversion to the very thing the nationalists say they detest—majority rule. We need to build a consensus, and Unionists must be included in such sensitive issues. If we exclude one community, we get not consensus but confrontation, which we need to move away from.
	A shared future must include everyone—not just one side of the community, but both sides—and it must respect the identity and tradition of both sides. I therefore urge the Secretary of State to support Northern Ireland politicians, because I believe the Government have a role to play in that. Politics is the only answer. As the right hon. Member for Neath has said, we need to consider initiatives to tackle social deprivation in areas where there is a disconnect.
	The DUP will provide leadership—the First Minister has stated that—but we need a level playing field. Right now, many people in Northern Ireland feel that the peace process has become skewed, and we need to correct that imbalance.

Theresa Villiers: It is a great regret and concern that the right hon. Gentleman and his family have been subjected to those threats and I pass on my sympathies to them. He is right that the way forward is to seek consensus, and one that respects the different identities present in modern Northern Ireland. I fully agree with him on the importance of the UK Government working closely with the Northern Ireland Executive on initiatives to regenerate and provide the economic prosperity that
	is vital to underpin the peace settlement in Northern Ireland. That is particularly important in deprived communities across Northern Ireland. I am happy to continue the work I have been doing since being appointed on how we can boost the Northern Ireland economy and attract jobs and inward investment from around the world.

Stephen Lloyd: I thank the Secretary of State for her statement and join her in deploring the attempted murder on 30 December by dissident republican groups.
	I am conscious of some of the figures the Secretary of State mentioned: there have been more than 100 arrests and 66 police officers have been injured. We should imagine the impact in England, Scotland or Wales if 66 police officers were injured over a period of about a month. There would be absolute uproar, so my appreciation and respect for the PSNI is second to none.
	I should like to emphasise the flag issue. I have been doing research in the past few weeks. Interestingly, I discovered that, in the city of Lisburn, all the political parties have reached an agreement, led by the DUP and the Ulster Unionist party—

Mr Speaker: Order. I very gently say to the hon. Gentleman that I extended a degree of latitude to the right hon. Member for Lagan Valley (Mr Donaldson)—that was a matter of discretion—but this is a statement to which the responses must be brief questions. I feel sure that the hon. Gentleman is now approaching his question mark.

Stephen Lloyd: Thank you, Mr Speaker. I am grateful for your reminder—I am approaching my question. Does the Secretary of State agree that it is incredibly important at this time that the political parties provide leadership and maturity, and that the leading political party in Northern Ireland needs to go that one step further in providing that leadership by accepting that democracy trumps everything?

Theresa Villiers: It is very important for the political parties to provide leadership in Northern Ireland and I am confident that they are doing so. They take this matter seriously. The events are a wake-up call to all of us—a reminder that we need to address the underlying causes of the tension, and to find ways in which to bring different parts of the community together to build mutual understanding, so that it becomes easier to resolve flags and symbols issues without provoking such distressing scenes on our streets.

Naomi Long: I join the Secretary of State in condemning the attempted murder of a police officer and his wife and family in my constituency by dissident republicans. I also join her and the shadow Secretary of State in commending the police for their professionalism under extreme pressure during the loyalist disturbances and riots, and for holding the line on behalf of the whole community of Northern Ireland between the rule of law and descent into chaos.
	The PSNI has assessed that senior members of the UVF in my constituency are involved in orchestrating that rioting and are participating in it. Combined with the dissident republican threat, we find ourselves in a
	grave situation in the general peace process. What role does the Secretary of State believe the UK Government can have in tackling not only that violent threat, but the deep-rooted sectarianism that is rampant in Northern Ireland, in trying to create a more stable foundation on which to build for the future? Does she agree that the only sustainable, lasting and enduring solutions in Northern Ireland will be found by us sharing responsibility and taking things forward on behalf of the whole community, and that such solutions will not be found in partisan and tribal options?

Theresa Villiers: I am grateful to the hon. Lady for her question. Yes, it remains a grave concern that individual members of the UVF are involved in the violence—I discussed that with the Chief Constable and the Justice Minister yesterday. Indeed, I passed on some names that had been provided to me on the matter.
	On the dissident republican threat, the riots create dangers and vulnerabilities for the PSNI that it would not otherwise have, as I have said. The increased presence of members of DR organisations in nationalist areas such as Short Strand is gravely worrying. The hon. Lady is right that the threat is real—those who are engaging in the violence are being reckless with the peace process.
	I also agree with the hon. Lady that it is important for the UK Government to be engaged in efforts to help the Northern Ireland Executive to make progress on a shared future. That is why such progress has been the focus of pretty much everything I have said as Secretary of State, why my predecessor returned to it again and again, and why the Prime Minister highlights it every time he visits Northern Ireland. It is vital that we see progress, and we are keen to work with the Northern Ireland Executive on those matters.
	I agree with the hon. Lady that sharing responsibility and building consensus is the way forward on sensitive issues such as flags, rather than seeking to change things through violence.

Conor Burns: May I associate myself with the Secretary of State’s words on the PSNI and the hon. Member for Belfast East (Naomi Long)?
	Two very important points have been made by the shadow Secretary of State and the former Secretary of State, the right hon. Member for Neath (Mr Hain). This is not about flags, but about something much more profound. When visiting Northern Ireland over the new year period, I spoke with residents in the Sandy Row and Shore road areas of Belfast. There is a profound sense of alienation in the deprivation of those communities, and a real sense that they are not being listened to by those they have elected. Will the Secretary of State join me in urging all elected politicians in Northern Ireland—Members of the Assembly, councillors and Members of Parliament—to get into those communities and listen, and will she listen to what they tell her about what we can do to improve the conditions in those communities?

Theresa Villiers: Certainly, in any democracy, it is vital for elected representatives to engage at the grass roots with members of the community who feel alienated. I urge all those who feel a sense of detachment from the
	political process to come forward. I imagine that many people who are rioting on the streets are probably not even registered to vote. There are many ways for them to express their political views and to support Britishness, and many ways to support the flying of the Union flag, that are peaceful and constructive, and that will work. There is a way forward. There is openness and an opportunity for those who genuinely care about our national flag to get involved in a broad conversation on how we resolve those issues. I encourage them to do so.

David Winnick: While recognising the social problems that unfortunately continue to exist in Northern Ireland, is it not necessary to make it perfectly clear that there can be no excuse whatever for violence or intimidation from either side? Is it not the case that the large majority of people in Northern Ireland support the peace settlement, which was started by John Major and negotiated successfully, following a change of Government, by Tony Blair and Mo Mowlam? Moreover, as a result of those negotiations, articles 2 and 3 of the Irish constitution were removed—the very articles that caused such annoyance and complaints from the Unionist community over many years.

Theresa Villiers: The hon. Gentleman is right. We should not forget everything that has been achieved by the peace process. He is also right that there is no excuse for violence, regardless of social background. It is important to recognise that although there are problems with sectarian division in Northern Ireland, there are many people who no longer share those sectarian views and have left them behind. We need to ensure that that becomes more broadly based across the community.

Bob Stewart: The House is still in shock about the death of the prison officer David Black. The second incident on 30 December sends us again into shock. It is an appalling regression to what might have happened in the past, and let us hope that we can get a grip of it. May I ask my right hon. Friend whether there has been evidence of weapons either being seen or used in the riots in Belfast?

Theresa Villiers: As I said in my statement, in one incident shots were fired at the police. My understanding is that the rounds were blank, but I am afraid that there is a ballistic threat in relation to these riots.

Thomas Docherty: Further to the point articulated by my hon. Friend the shadow Secretary of State, on education, and as one who, as a former student leader, worked with the National Union of Students-Union of Students in Ireland as long ago as the late ’90s, it is clear there is a generation of young male Protestants who have not achieved their full education potential, and have been educated in crumbling schools with no great drive to go on to further and higher education. Will the Secretary of State listen to the cross-party pleas to help the Executive to invest more in education to give all parts of the community in Northern Ireland a real future?

Theresa Villiers: The hon. Gentleman is absolutely right that educational opportunities are key to addressing some underlying problems. This is an issue I have discussed with a number of community groups, for example, a
	great organisation called the Resurgam Trust in the Lisburn area. There is a crucial opportunity for the early intervention programmes that have proved so successful in many parts of the United Kingdom. It is not for the UK Government to dictate to the Executive how much of a priority they give to that, but we are very supportive of the work that is being done. He is right that this is a key way to improve the current situation.

Oliver Colvile: I thank my right hon. Friend for her well-thought-through statement. Has she made an assessment on whether this is localised to Belfast, or is it a broader issue? May I also ask her what can we do to ensure better school results in Northern Ireland? I understand that there is success in some places, but that in others only 3% or 4% of children end up getting five GCSEs or more.

Theresa Villiers: The Northern Ireland education system has significant contrasts. For many children, it is spectacularly successful, and, of course, it has two world-class universities. However, there is a concern about those for whom it is not delivering and a concern about educational underachievement. As I said, this is a high priority for the Northern Ireland Executive and the Education Minister, and the UK Government continue to support them through the block grant they give to Northern Ireland. I am very happy to work with the Northern Ireland Executive on the good work they are doing to improve the current situation.

Kate Hoey: I agree wholeheartedly with the remarks made by the hon. Member for Bournemouth West (Conor Burns). There have been a lot of glib phrases about a shared future. Will the Secretary of State define for the House what she means by a shared future? Many people from the majority Unionist community feel bewildered that the British Government and the British Opposition are campaigning to keep Scotland part of the United Kingdom, while in Northern Ireland we are talking about a shared future. Why are we not talking about a shared future in Scotland, and why are we not putting the same resources and support into keeping Northern Ireland as part of the United Kingdom?

Theresa Villiers: As the hon. Lady will be aware, and I am sure she will agree with me, the question of Northern Ireland’s future in the Union is settled on the basis of consent. The Government are not neutral on the Union and we believe that Northern Ireland’s place in the United Kingdom is safer than it has been for many years. Regardless of that, it is crucial to find ways to unite the community in Northern Ireland. It is true that there remain sectarian divisions. On the subject of Scotland, I know that there are indeed some concerns about sectarianism there, although it does not manifest itself in the same ways as it does in Northern Ireland. It is true that many people in Northern Ireland have left those sectarian divisions behind, but not everyone has. We need to give children the opportunity to participate in shared education, and look at ways to have space that can be genuinely lived in, occupied and used by both parts of the community. In particular, I single out some
	of the education initiatives in County Fermanagh, which have demonstrated that it is possible to give children the opportunity to be educated alongside those from other backgrounds in a successful way. Those are the sorts of initiatives we need to deliver.

Dan Rogerson: I thank the Secretary of State for her statement and join with her in praising the PSNI for all it is doing to maintain peace in the Province of Northern Ireland. Does she agree, as we try to continue the peace process and move towards reconciliation, that all political leaders should be very careful in their use of language and what they put into print, to ensure that they do not create a climate that leads to a feeling of justification for other measures that people unfortunately take that are beyond the bounds of political debate?

Theresa Villiers: I agree that it is important that inflammatory language is avoided, because we can see the potentially disastrous consequences to which it can lead.

Paul Goggins: I join the Secretary of State in praising the bravery of PSNI officers, particularly in recent days and nights. She is right, and the Prime Minister was right yesterday, to underline the vital responsibility that every politician in Northern Ireland has to map out a shared future to which everybody, including disaffected loyalist communities, can feel they belong. One area that she retains responsibility for is the work of the Parades Commission. Given that we are just weeks away from the start of this year’s parading season, will she update the House on recent discussions she has had with members of the commission about the role that they can play, alongside police and community leaders, to make sure that parades, and indeed legitimate protests, are properly stewarded and responsibly organised?

Theresa Villiers: I met the whole Parades Commission just a few days ago to discuss its thoughts on the forthcoming year. Technically speaking, I think the parading season begins in mid-February. The commission takes its role very seriously and there was some progress last year on public order issues related to parading. It is focused on doing the best it can to make the right decisions that are balanced and fair, and to take into account competing considerations. I take this opportunity to pay tribute to the work of the right hon. Gentleman, and members of his Government, in building peace and calling for the same kind of shared future that the Prime Minister has focused on so strongly during his term of office.

Andrew Turner: Further to the decision of Belfast city council on which days the Union flag may be flown, what steps is my right hon. Friend taking to ensure that all citizens of Northern Ireland feel that they can express their views, including by the ballot box, rather than being disengaged as so many seem to be?

Theresa Villiers: It is important for this House to send out a clear signal that there are a whole range of ways that people can get involved in the political process, whether they express their views by e-mailing their MP, using social media sites, or coming along to public
	meetings. That is the way to influence the outcome of important debates on the future of Northern Ireland—not by chucking bricks at police officers.

Gemma Doyle: It is my understanding that when Scotland hosted the G8, additional policing resources were not provided. I think the Secretary of State said that they would be provided in Northern Ireland this year—can she confirm that point? Will she also confirm whether the Chief Constable has asked for additional resources to deal with the ongoing violence?

Theresa Villiers: The Chief Constable has not asked for additional resources to deal with the ongoing violence, but he is making a careful assessment of the impact of the violence on his resources. The resources needed to police the G8 summit are under consideration, and we are working with colleagues in the Home Office and the PSNI to see what might be possible. It is also important to emphasise that the £200 million deployed by the Government to assist the security efforts in Northern Ireland have played an important part during the riots, not least because it has funded the vehicles that have come under attack—the capital renewal of the PSNI’s vehicle stock was partly funded by the extra £200 million.

Bob Blackman: The saddest aspect of this senseless violence is the potential deterrent effect on business investment and tourism. Will my hon. Friend update the House on conversations she has had with business leaders, retailers and other potential employers on improving the Northern Ireland economy, increasing investment and creating new jobs?

Theresa Villiers: Virtually every day I am in Northern Ireland, I am in those kinds of discussions, because it is crucial that Northern Ireland’s economy recovers. We saw some fabulous, successful events last year, including the Titanic centenary events and the Queen’s visit, and, as I have said, this year again we have opportunities to showcase all that is good about Northern Ireland. I am enthusiastically taking part in that, and I know that the
	Prime Minister will be doing so as well during his forthcoming visits to Northern Ireland, including for the G8. We are confident that we can host a successful and secure G8 summit, despite the recent disorder.

Toby Perkins: I was struck during the statement by the sense of disengagement in certain parts of the community, but I have been less clear about the Secretary of State’s strategic vision for dealing with that. Will she be a bit more specific about the steps that will be taken to try and engage some of these communities? Simply asking them to come forward is not a solution. Will she tell us specifically what she is doing, with the First Minister and Deputy First Minister, to engage some of these communities?

Theresa Villiers: As I said, I have regular discussions with the First Minister and Deputy First Minister. Today sees the first meeting of the Unionist forum, which will be engaging with members of the Unionist community, and, as I have said, I and the Minister of State are focused on wide and inclusive engagement on all the challenges facing Northern Ireland. It is important for the Northern Ireland Executive to continue the work to build a shared future and to engage with disaffected communities. A key way to do that is by focusing on educational under-achievement and the sorts of social problems we have debated this morning.

Andrew Stephenson: I join my right hon. Friend in paying tribute to the PSNI, which has behaved with professionalism and bravery in the face of intense provocation and attacks over recent weeks. I expect it will be almost impossible to put a cost on the economic and reputational damage to Northern Ireland, but has she been able yet to estimate the policing costs so far of the recent protests and disorder?

Theresa Villiers: Various unofficial figures are circulating, and it is deeply regrettable that resources that could be going into visible community policing and confidence building are being taken up by rioting. As I said, the Chief Constable is looking carefully at the implications of the situation for his resources and will keep me updated.

Backbench Business
	 — 
	Dementia

Nigel Evans: After Mr Burstow has finished his contribution, I will announce whether there is to be a time limit, and, if there is, what it is.

Paul Burstow: I thank the Backbench Business Committee for the timely opportunity to debate on the Floor of the House this most important of issues. I also thank my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for her commitment to, and interest in, these issues and her determination to ensure this debate took place today, and the right hon. Member for Salford and Eccles (Hazel Blears), who chairs the all-party group on dementia. Together, the three of us argued the case for this debate to come to the House, and I look forward to their contributions. They are both passionate about this issue.
	Earlier this week, I was at an event at which the daughter of an 86-year-old woman with dementia said some things that spoke to what this debate is all about. She talked about being a full-time carer for her mother and about the agonising decision to move her mother into a care home. She said that although death and moving house were probably the two most traumatic events in our lives, dementia was a never-ending bereavement and that the daily trauma had robbed her and her mother of life. Such true-life experiences, many more of which I hope will come out in today’s debate, make it plain why dementia is now the disease most feared by the over-55s.
	My interest in the issue goes back well over a decade and was started by a report that I read into the inappropriate and, in some cases almost abusive, use of anti-psychotic medication. Even then, the side effects were beginning to be well documented and understood, so it is no wonder that at the time these anti-psychotics were labelled as a chemical cosh. As the evidence has mounted over the last decade or so of the increased risk of stroke as a result of these drugs and of the fact that they can shorten lives, I was prompted to ask endless parliamentary questions to Ministers about the matter and to produce a series of reports. At times, it felt a bit like banging my head against a brick wall.
	I am pleased to say that the wall has started to tumble and that things have begun to change, and, in the last two and a half years, we have seen a 52% reduction in the prescription of these drugs to individuals receiving them for inappropriate reasons. As a result, lives have been saved and lives have been changed. But—and it is an important but—the Prime Minister’s progress report on his dementia challenge made it clear that there is no room for complacency and that there is still too much regional variation in the use of these drugs to manage people with dementia and too much prescribing. I hope that the Minister will tell us what the next steps will be, when the next audit, which has been committed to, will take place and be published and what other steps he thinks will be necessary to ensure that we achieve the goal of a two-thirds reduction in prescribing.
	I pay tribute to Clare Gerada, president of the Royal College of General Practitioners, who was instrumental in getting the co-operation of GPs for the necessary
	surveys to understand prescribing practice and who has led some of the change in culture and behaviour in this area. I also pay tribute to the last Labour Government—not something I always do—for producing the first national dementia strategy. It was one of the first in the world, in fact, and should be recognised as an important contribution.
	When I became care services Minister in May 2010, I had to make a judgment: did we carry on the road laid out in that strategy, or did we start again? I took the view that we should use the strategy as the foundation for future action, and I am pleased to say that, as a result, the Government have done a lot to deliver on the strategy and go beyond it, through the creation of a dementia action alliance, bringing many different organisations together in a common cause, through clearer commissioning guidance, through collaboration with the Design Council and through funding the Life Story Network to run training courses. The latter is a small thing, but it makes a big, big difference: by telling our stories and understanding who we are, we start to look beyond the diagnosis of dementia, and, as a result, we start to treat the person, not just the disease.
	Furthermore, the audit of dementia services has given us a handle on where different parts of the country have reached in developing their services and has led to new incentives in hospitals to support best practice and the much-valued—I hope—analytical tools that will help to drive up diagnosis rates, which are still far too low. Following the research call made just over a year ago, I was delighted to see just last week that £20 million of funding has now gone to new dementia research projects. That far exceeds what I expected at the time as a Minister and certainly what many officials in the Department expected. It really is fantastic news.
	The Prime Minister’s dementia challenge has put dementia centre stage, promoting dementia-friendly communities and raising the bar for early diagnosis and quality of care, along with ensuring vital dementia research too. There is a lot happening and it can happen back in our constituencies as well. All of us have an opportunity—and, I believe, a responsibility—to challenge our local services to do more to become more dementia-friendly and ensure that they learn the lessons from best practice. However, there are some questions that the Minister needs to answer about what comes next. The current dementia strategy runs its course in 2014. What comes next? In my view, there has to be a successor strategy—one that is perhaps different from the current strategy in a number of ways, building on the work being done as a result of the Prime Minister’s dementia challenge.
	That challenge is a challenge to the whole of Whitehall, not just the Department of Health. Every Department should be a catalyst for action on dementia within its sphere of responsibilities. Indeed, just before Christmas I tabled a series of parliamentary questions to try to establish what each Department was doing to support the dementia challenge. The answers I received were highly variable. Not all Departments seem to have clocked the fact that they could materially do something to make a difference in their sphere of responsibilities. I hope we can pick up on what the Prime Minister said about this being a challenge that cuts right across society, as well as ensuring that it is picked up and
	understood right across government. Any new strategy needs to embed dementia-friendly thinking right across Whitehall.
	We cannot have a debate such as this and not talk about carers. It is important to stress and value the role that family carers play. That is why I was pleased to see recently that the National Institute for Health and Clinical Excellence has launched a consultation on new indicators in the quality and outcomes framework for identifying carers of people with dementia. That is fantastic, but what about all the carers who do not happen to be caring for someone with dementia? On this occasion I think it is wrong to single out one disease. I hope that others will make that comment in the consultation too. The most recent research by the Carers Trust into the NHS and carers’ breaks continues to make depressing reading, however. Too much of the NHS is still ignoring carers and not doing enough to passport the money that this Government have committed to carers’ breaks and make them a reality. As the NHS increasingly wakes up to the big challenge of supporting people with dementia and other long-term health conditions, it needs to wake up to its role in supporting carers too.
	I have already mentioned that I was pleased to see the increased research funding that is coming through. I was delighted in 2010 when the coalition programme included a commitment to dementia research. That is a commitment that I lobbied the then Liberal Democrat health spokesman—now the Minister on the Front Bench—to include in our manifesto. Although there has been progress—with a road map now setting the direction of travel, a challenge group bringing various players together and a commitment to double research spending—I found myself becoming increasingly frustrated as a Minister by what I felt to be a poverty of ambition when measured against the burden of disease that dementia represents. We are not yet doing enough—we do not yet have the critical mass—to reach the scale and pace necessary to gain the understanding and insights that we need to make the breakthroughs. The £20 million from the research call is fantastic and I hope it will make a difference, but we still have lessons to learn from the journey made by the cancer research movement. I believe the dementia research challenge group itself needs to be challenged more. We need a long-term plan for dementia research and a sustained increase in funding for at least the next decade. This is about a common endeavour—a collaboration, as it were—between the research funders and the research community, so that we make a concerted effort to expand our knowledge of this disease, to diagnose and treat it and, ultimately, to understand and defeat it.

John Pugh: I am listening carefully to my right hon. Friend, but dementia is clearly not an English disease; rather, it is an international threat. Is there not scope for massive international collaboration on what is an issue confronting all nations?

Paul Burstow: My hon. Friend makes an important point. Yes, there is scope for that; indeed, many research organisations in this field are already collaborating internationally. However, as a country with a very reputable
	research tradition, it is important that we should be in the vanguard of that research and put in place the necessary infrastructure to drive it forward.

Huw Irranca-Davies: I thank the right hon. Gentleman for giving way and welcome his very good introduction to this debate. I would make the same point about research within the UK. Post devolution, we often tend to look at it in terms of the different nations and regions in the UK. We should be sharing the best expertise and best practice right across the nations, because 800 of my constituents have been diagnosed—I suspect that there are many more who have not and they, too, need the very best assistance and support.

Paul Burstow: One of the great things about devolution is that we can try out different things in different jurisdictions, but it is great only if we learn from that by taking the best and using it elsewhere. I therefore agree entirely with the hon. Gentleman that that is an important part of this debate. The ability to exchange and learn—and, yes, sometimes reject things that others are doing—is important.
	My final point is about reform. I hope this year might be a tipping point for dementia. Reform of our broken care and support system has never felt closer. For people with dementia and the families who care for them, it cannot come soon enough. When the Prime Minister launched the dementia challenge back in March last year, he acknowledged the catastrophic costs that some people incur as a result of drawing the card in the lottery of life that says “Dementia”. He said:
	“We are determined to do the right thing by these people”.
	A dementia diagnosis is traumatic enough, without the knowledge that care costs can often spiral out of control as the disease progresses. While care financing is left unreformed, people with dementia face the prospect of losing both who they are and everything they have ever worked for.
	I therefore very much welcome the news in Monday’s mid-term progress report that the Government are to press ahead with a cap and increased means test, and the confirmation that the House received on Tuesday from my right hon. Friend the Deputy Prime Minister that the necessary legislation will be enacted in the lifetime of this Parliament. In my capacity as Chair of the parliamentary inquiry into the draft Care and Support Bill, let me tell the Minister that the Committee has made it clear to me—and I absolutely agree—that we expect as much detail as possible on any new clauses or other changes that will flow from the introduction of a capped cost system into the legislation, so that we can do the House the service that we have been asked to perform, which is to report on and scrutinise the provisions and help the Government to introduce the best possible legislation to Parliament.

Norman Lamb: Let me confirm to my right hon. Friend that I want to do everything I can to ensure that the Committee is as informed as possible, so that it can do the important scrutiny work that it is charged with doing. Let me also take this opportunity to pay tribute to the work that he did as my predecessor to push the dementia debate forward and make substantial progress.

Paul Burstow: I am grateful to my hon. Friend and look forward to that collaborative approach to the Committee’s work.
	I want to end by quoting from an e-mail I received recently. Hon. Members might be aware that I made some comments last week about one way in which I thought this policy change might be paid for. That generated quite a lot of responses; this is one of the ones I think I can quote in the House. It says:
	“Tonight I am sitting on my own in the kitchen of our family home surrounded by a lifetime of mum’s possessions, all full of memories from certain times of our lives, while mum is in a care home blissfully (and thankfully) ignorant of my turmoil.
	This has to be the lowest point in my life.
	Not only coming to terms with the complexities both mentally and physically of dementia, realising I’ve lost my mum even though she’s still here, but stumbling through the bureaucratic minefield of trying to obtain funding and the emotional pressure of raising money by selling off, in effect, mum’s ‘life’.”
	That is really what this debate is about. It is about people’s lives and how we can make them better. It is about how we can make the terrible journey through dementia as good as it possibly can be, and how we can secure the common good of having the right services at the right time. I look forward to hearing other hon. Members’ contributions to the debate.

Several hon. Members: rose —

Nigel Evans: Order. We are going to be brave—or foolish—and start without a time limit on Back-Bench speeches, but it would be helpful if people could aim to speak for 10 to 12 minutes. Anything beyond that would not be helpful.

Hazel Blears: I am grateful for your guidance, Mr Deputy Speaker. It is a pleasure to follow the right hon. Member for Sutton and Cheam (Paul Burstow). In my capacity as vice-chair of the all-party parliamentary group on dementia—the right hon. Gentleman elevated me in his speech; our group is incredibly well led by Baroness Sally Greengross—I want to pay tribute to his work in this field. I appreciated his personal drive on this issue; it has made a big difference. I should like to thank the Backbench Business Committee for allocating the time for this debate. I should also like to thank all the Members here today. This is a fantastically good turn-out for a one-line Whip, Back-Bench business debate on a Thursday afternoon, and it indicates just how deeply people feel about this issue. The hon. Member for Chatham and Aylesford (Tracey Crouch) has been a tremendous help on the all-party group, and I am delighted to be vice-chair alongside her. Her personal drive and commitment have made a big difference.
	Nearly 1 million people will be living with dementia by 2020, and the issue now touches the lives of virtually every family in Britain. It is a big issue for the NHS, but it is also a big issue for all the public services. I entirely endorse the right hon. Gentleman’s point that we have to join up the services right across Whitehall if we are going to make the progress that we need to make.
	Ten years ago, when I was a Health Minister, it is fair to say that dementia was not at the top of the agenda for Ministers or for the NHS. As ever, there were more pressing issues, such as cancer, heart disease, waiting
	lists, maternity services—the list goes on. The voices raising the issue of dementia, and of care for older people more generally, were not heard as clearly then as, thankfully, they are today. This is now a massive challenge facing all of us, and I believe that increasing pressure from the public has helped to focus the minds of politicians and practitioners on what can and should be done to support those with dementia and, crucially, the people who care for them.
	I also want to depart from normal practice and pay a warm tribute to the Prime Minister. He has put his personal weight behind this issue, and I know from having been a Minister that having the Prime Minister behind a project can give it momentum and get the system moving. It can provide a kick-start and a catalyst. I want to say a genuine thank you to the Prime Minister on this issue. That does not mean that there is not much more to do, and there are certainly concerns about ongoing funding issues, but having the Prime Minister say, “This is my challenge; I am behind it” will get things moving in the system.
	Like most people, I got involved in this issue because someone I love has dementia. It is my mum. Over the past five years, I have seen and experienced the impact of that on her and on my dad, who, at the age of 83, is still her full-time carer. I want to raise three issues today. I want to talk about diagnosis, support in the community and the research challenge that we face.
	My mum’s diagnosis was absolutely appalling. She had been having problems with her memory for about a year and a half and, like many people, she thought that it was just because she was getting older that she could not remember day-to-day details. However, when she could not remember the day of the week and when she started constantly to repeat herself, we as a family thought that she would benefit from a bit of expert advice.
	Mum’s GP was not bad. He referred her to the mental health team for older people. She was just 70 at the time. What happened after that, however, was absolutely terrible. My mum and dad received a visit from a local psychiatrist whom they had never met before. She sat herself down on the settee without any formalities and proceeded to ask my mum 10 questions about the day, the date and who the Prime Minister was—I can think of lots of people who would not have known who the Prime Minister was—and after just a few minutes, announced to my mum and dad that it was very clear that my mum had Alzheimer’s. As Members can imagine, they were stunned and upset. They had no idea what that meant for them or what the future might hold. They were frightened and bewildered.
	That was just the kind of brutal diagnosis that we used to hear about in relation to cancer sufferers, but here it was happening to the people I love. Suffice it to say that, after a formal complaint, we did not see that psychiatrist again, but the incident brought home to me how many people in those circumstances are subject to such hurtful and damaging insensitivity. Better dementia diagnosis has to be a priority. Yes, this is about earlier diagnosis, but it is also about sensitivity, understanding and finding the right circumstances in which to make a diagnosis that will fundamentally affect people’s lives.
	Diagnosis rates in this country are low and incredibly varied. In general, just over 40% of people with dementia receive a formal diagnosis. The lowest rate is 26%, in
	Dorset, and the highest is nearly 70%, in Belfast. There must be a reason for such a dramatic variation. We have made little progress in recent years towards driving up diagnosis rates, yet diagnosis is key, because without it, a person cannot gain access to the support services and the help that they need.

Tony Baldry: Is it not part of the problem that many GPs are anxious not to diagnose dementia because they feel frustrated that they do not know what to do following such a diagnosis? They do not know what to offer the patient, and there seems to be an inclination to avoid that frustration by not making a diagnosis of dementia at all.

Hazel Blears: The hon. Gentleman is absolutely right. In fact, the recent all-party group inquiry into diagnosis revealed exactly that situation, which is a real concern. Many GPs are uncomfortable about making a diagnosis of dementia. They sometimes feel that such a diagnosis is pointless if the necessary drug treatments or wraparound care and support services are not available. Increasing the confidence of GPs at that point to enable them to make a diagnosis is of fundamental importance.
	The figures on diagnosis are quite stunning. Only half the GPs questioned said that they had sufficient training in this area, and a third of them believed that a lack of access to drug treatments was a barrier to early diagnosis. Almost a third were not confident about making a diagnosis of dementia, and only a third felt that they had had enough training to go through the diagnosis process. Unless we tackle that, we will not get the increase in diagnosis that the Prime Minister and all of us want.

Nick de Bois: I have listened carefully to what the right hon. Lady has said. She mentioned that Belfast had a high rate of diagnosis, at 70%. The figure in my constituency is around 36%. During her inquiry, was there any attempt to establish why best practice or prevailing factors could not be transferred and learned across the spectrum, in order to improve the situation?

Hazel Blears: Yes, there was. The all-party group had an interesting presentation from the Scottish Health Department. Diagnosis rates in Scotland are very high indeed, and we learned that the highly organised, managed and focused system there was driving up diagnosis. It is driven, to some extent, from the centre, and I know that that is not always popular these days, but the drive from the centre out to the GPs is really making a difference. I think that there is room for us to adopt a more driven process—it need not necessarily be more centralised—in which GPs are more accountable and in which they report back on rates of diagnosis. There is much more that we can do in that regard.
	Diagnosis is a problem, but once a diagnosis has been made, the availability of support in the community becomes relevant. There are many problems in that area. Our inquiry revealed that many carers felt that nothing happened after the diagnosis, because there was no help or support available. In my area in Salford, we are lucky. We have one of the 10 national demonstration
	projects established under the national dementia strategy in 2009, and we are developing some really innovative services in the community. I should perhaps declare an interest: my mum attends the centre two days a week, and I sit on the strategic board that drives the process there. I have seen that when people are really committed to such projects, they can make a huge difference.
	Our centre is the result of a partnership between the local authority and the Humphrey Booth charity, which has existed in Salford since the year 1600. It is a marvellous example of people working together. The centre is known as the Poppy Centre, and its facilities include a dementia singing group, on a Wednesday, which attracts 150 people. That is an incredible resource. The centre also offers day centre services, art work, music, personal tailored care, a dementia café for when friends and family drop in, living history, hairdressing and hand massage. It is a wonderful place, staffed by brilliant people.

Alison McGovern: I apologise to my right hon. Friend and other Members because I cannot stay for the whole debate. The lesson I have learned from her expertise and from the evidence I have heard about Salford on this and other occasions is that we cannot think in the old way about how we help people with dementia; we have to be creative and provide the best range of services possible.

Hazel Blears: My hon. Friend is absolutely right. We are at the beginning of the kind of innovative care that she talks about. One thing we need to do is to get more young people and more young clinicians involved in this area, because that is how we will see innovation coming through.
	We have a brilliant centre in Salford run by the manager Sue Skeer. There is also Sue Smyth and Nicola Fletcher, and users and carers are on our board. Margaret and Fred Pickering are an inspiration: Fred has dementia, Margaret is his carer and the whole of our practice is driven by users and carers at the centre. We are lucky, but many places have nothing like the Poppy day centre to support them.
	We want to make Salford a dementia-friendly community and to make sure that transport, housing, leisure and local shops are all aware of the issues around dementia. My local university in Salford is setting up a dementia centre—a collaboration between the department of the built environment, including architects, and the department of social care. Design is being looked at really seriously. A marvellous Italian Professor Ricardo Codinhoto and a wonderful nurse, Natalie Yates-Bolton have inaugurated not just the design centre at Salford university, but now a European collaboration so that we will have an international design network on how we can make dementia-friendly communities work.
	My question to the Minister on dementia-friendly communities, which we hope to be in Salford and which York, Plymouth and other places are pursuing, is: what resources have the Government committed to support the work of these communities, and how will it be sustained in the long term? We can push on, but we need a resource to make it happen. Yesterday, I met Duncan Selbie, the new director of Public Health England, who is going to make dementia a national priority for
	public health, so there really is commitment and energy behind all this. I want to hear from the Government what they can do to help.
	Let me briefly cover my second theme—I have accepted two interventions—which is about the research challenge. I met the Wellcome Trust this week, and I was hugely encouraged by its willingness to put serious research funding into this area. It is looking not just at clinical research, which it might have done in the past, but at research on “living well with dementia”, recognising the importance of a holistic approach. I was impressed, too, when I met David Lynn and Dr John Williams. They acknowledged the difficulty of this area because there is so much that we still do not know about the brain. Nevertheless, despite the failure of the recent clinical trials, the data from them could prove very useful in taking us forward to the next steps, which we hope will help us find drugs that will at least slow down or delay the onset of Alzheimer’s. What everyone who has Alzheimer’s wants is a cure; they are desperate to get some progress here.
	If we have a really big push on research, I feel that progress could be made. Our scientists are some of the best in the world in this area, yet for every six scientists working on cancer, only one works on dementia. Only 2.5% of the Government’s research budget goes to dementia, with 25% going to cancer. We should look at the progress made in cancer over the last 20 or 30 years; I do not want to wait another 25 or 30 years to make the same progress for the hundreds of thousands of people who are suffering from dementia now. The Government really must press on.
	There are many people out there who want to help us. Just this week, the Daily Mail featured a long article about the possible benefits of coconut oil and the work done on that at Oxford. I have no idea whether that is likely to help people. It has helped some families, but we can see from that the absolute desperation people have to try to find something that can help the life of their loved one. Research is thus a huge challenge, as is help in the community.
	I want to express some concerns about where we are at the moment. It is a time of great change in the health service. We are moving from primary care trusts to clinical commissioning groups, and it could be a time of instability. I am worried about the expertise—or lack of it—in the clinical commissioning groups when it comes to commissioning for something as complex as dementia. I want every CCG to have a lead for dementia, developing expertise and knowledge so that they know how to get the best from the money available. I would like to hear the Minister say that he wants to see a dementia lead in every CCG.
	My final point is about the resources available to us. Over the last three years, my local authority has faced cuts of £876,000—30% of the adult social care budget. I know the Government will say that they have put £1 billion back in and that £1 billion has been lost, but when the budget is not ring-fenced, it can easily get spent on other issues. It is virtually impossible for councils to meet their targets without looking at the adult social care budget, which is 40% of their overall expenditure. That is why we can see day centres closing. They are an essential support network, providing a lifeline for carers, yet they are being cut. I am very worried indeed—not just about local authority cuts, but
	about buddying services provided by Age Concern. These voluntary and third-sector groups, so essential to people, are now quite fragile.
	I am sure that the future funding of social care is going to be discussed. I make a plea: please can we have the cap at a level that helps the majority of families that need to be helped. If it is set at £75,000, I will be worried that those who really need the help will not receive it.
	I think we are now at a point where progress can be made of the kind that has probably not been made for years. I really hope that we can press forward on a cross-party basis. We need a long-term settlement so that we can support people at what is probably the most difficult and frightening time of their lives.
	I remember what it felt like to discover that my mum had dementia and that her future would be so different from the one that her and my dad planned together. We have been lucky in that we have been able to speak up and get help and support from the fantastic caring people at the Poppy centre, but it is hard for many people who might not have a strong voice or someone to advocate on their behalf. My mum instilled in me that sense of justice and fairness, which has driven me throughout my political life. I know that she would want me to continue to fight for all those who often find themselves bewildered and powerless, and to make sure that they are treated with care and dignity. We owe them all nothing less.

Tracey Crouch: It is an honour and a pleasure to follow what ended as a very moving speech by the right hon. Member for Salford and Eccles (Hazel Blears). She is a fantastic fellow vice-chairman of the all-party group, and a real champion on this issue. I would also like to take the opportunity to pay tribute to the right hon. Member for Sutton and Cheam (Paul Burstow), who I thought progressed this issue as a Minister much further and much quicker than did previous Ministers.
	I start my comments this afternoon with an explanation of what sparked my interest in this incredibly important issue. As a parliamentary candidate, two events collided and aroused an immense passion about dementia that will stay with me for ever. I cannot quite recall the precise sequence of events, but one was personal and one was professional.
	The first was my father calling me to tell me that his mother, Nana Crouch, had been diagnosed with dementia. My beloved grandfather passed away when I was a teenager. Following her diagnosis with this awful condition, nana regressed quickly and was transferred into residential care for her own safety. I went to see her, but she was so confused about who I was that she became quite frightened and I left concerned for her own mental well-being. It was very upsetting to see a lady I respected and loved hide in a corner cowering with fear.
	The second event involved me knocking on the door of a man called Maurice. He and I remain friends today, despite our political differences. At the time, Maurice’s wife was still alive but was in a care home suffering from dementia. Maurice is a great man, one with a military background and one who had his whole world of traditional male-female relationships turned upside down when he suddenly had to care for his wife.
	The challenges that Maurice faced are ones that many carers are exposed to, but his real concern—one I now share—was the poor care his wife received while she was in hospital for a minor injury, where her health care needs were exacerbated by her dementia.
	This issue of inadequate hospital care for dementia sufferers is a substantial one. While there is much evidence of good practice, there is an unacceptable variation in the quality of care. Maurice has become a pain in the proverbial, albeit in a good way, to local health care organisations. He champions the need for better care for dementia sufferers in hospitals—and rightly so. Of the carers responding to the Alzheimer’s Society’s “Counting the Cost” report, 77% stated that they were dissatisfied with the overall quality of care provided to people with dementia in hospitals. The key reasons included nurses not recognising or understanding dementia, lack of person-centred care, patients not being helped to eat or drink and patients being shown a lack of dignity and respect.
	The issue has been highlighted many times, most recently in a report from the Royal College of Nursing. Staff training, for which nurses themselves are calling, would constitute a vital step towards the addressing of those inadequacies. However, we must also achieve the correct balance between health care assistants and nursing staff, which is vital to the provision of personalised care in hospitals. All too frequently the problem is not the number of staff, but the fact that the ratio of health care assistants to nurses is too large, and nurses are therefore unable to support staff sufficiently.
	Unnecessary admissions and prolonged stays in hospital are expensive, and much too often they have negative effects on health and well-being. The all-party group looked into that and the cost to the NHS. I personally favour the notion of the halfway house: a service that could provide a primary care facility for those requiring medical attention for, say, a broken bone or a superficial wound, but in a less hospitalised environment. Not only might that be more cost-effective for the NHS, but it could address the issue of institutionalisation. One in four people in hospital beds have dementia, and, on average, people with dementia stay in hospital a week longer than those without dementia who are being treated for the same injury.
	People with dementia often become extremely distressed by ordinary events, such as meal times, and need extra help. If food is just left in front of them, they will not necessarily eat it even if they are hungry. It might be helpful for carers or family members to be present when they are served their food, but most hospitals do not currently allow visitors at meal times. I am keen to hear from the Minister what measures are being introduced to make hospitals more dementia-friendly, and, in particular, what action is being taken to increase dementia awareness and understanding among hospital staff.
	I am delighted that the Prime Minister is personally taking an interest in the issue after launching the dementia challenge. One of the more creative aspects of the challenge relates to the importance of dementia-friendly communities. I have observed three local initiatives that, although they have only just begun, have the potential to evolve into wonderful examples of how to meet that
	challenge. The first was the Alzheimer’s Society roadshow that took place recently at a local Tesco store. More than 55 people visited the vehicle in two days to obtain help, support and advice, 17 of them engaging in one-to-one sessions. Six new people accessed local dementia cafés as a direct result of the roadshow. I must say that I am a huge fan of dementia cafés: I think that they are bringing real value to our local communities.
	The second initiative is run by Asda Chatham, which rather movingly granted Christmas wishes to those in a local dementia care home. I was there to help, and talked to the manager during the event. He is keen to ensure that his staff have a better awareness and understanding of dementia, so that they can understand and help when someone is standing at the till feeling confused by something as simple as the coinage in their purse—coins that they do not recognise as the coins from their childhood. We have seen instances in which people stand and stare at oranges, for instance, for a significantly long time, and someone comes along and helps them to understand, making them feel less confused and more relaxed about the environment that they have suddenly realised they are in. I think that our local supermarkets have a key role to play in that regard.
	The third example is the fabulous work of Kent fire and rescue service in preventing vulnerable people from harming themselves while living at home. It is a trusted service, and it is doing its bit to help. We heard on the radio recently that in Kent—although not in my constituency—a man with dementia had rather sadly put his pyjamas in the microwave, and had almost set his house on fire. Members of the fire and rescue service arrived and sprayed a retardant over most of the house to ensure that he and his wife could live there safely without the risk of fire.
	As the right hon. Member for Sutton and Cheam pointed out, dementia is not just a problem for the Department of Health and local authorities, but an issue for the whole community. Every individual, organisation and department needs to play a part in changing society and its attitudes to a disease from which more than a million members of the population will be suffering by 2021. We need better collaboration and integration across different sectors, and we need to establish how limited resources can be used more efficiently and effectively.
	People can and should be able to live well with dementia. We want people to live in their own homes for longer, not only because that is better for them but because it is financially prudent. Early intervention via better, quicker diagnosis is essential. Medication and memory clinics mean that we can now live well with dementia for longer if it is identified early, but at present only 40% of people with dementia receive a formal diagnosis, and that is not good enough.
	I recently undertook an anonymous survey of GPs in my constituency. The problem highlighted most frequently was limited time with the patient. A standard 10-minute appointment is not necessarily sufficient in view of the complexity of the disease. When I asked what authorities could do to improve diagnosis rates, one key theme emerged: the need for quicker access to specialised staff, whether that would mean nurses in the community or shorter memory-clinic waiting times. There is such a difference between the worst case of a nine-month waiting
	time for memory-clinic services and a waiting time of 24 hours, which is best practice. If a day’s wait is possible somewhere, it should be possible everywhere.
	Another vital aspect of ensuring that people live well in their own communities is support for carers. We must do all that we can to give those whose world has been turned upside down the time, advice and respite they need. My constituent, Ron, had quite a good experience of the support that was available, and when his late wife was diagnosed with dementia, organisations and services contacted him very soon afterwards. He was provided with a range of support, aimed at the needs of a carer, by Crossroads Care, Admiral Nurses and the Maidstone & Malling Carers Project, but that does not always happen. Other constituents who have contacted me have been completely lost and alone, dealing with the volatile and confused behaviour of their loved ones with little or no support.
	It is imperative that we ensure that, following diagnosis, all carers receive a list of services and support in their area. That does not naturally happen at present, but it is important for the person suffering from dementia and for the carers. Ron told me about a book that one of the charities had given him providing a comprehensive list of common difficulties that arise for a person caring for someone with dementia, along with simple and straightforward ways to overcome them. He told me that it was a lifeline and a bible. Will the Minister ensure that a copy is available on the new “Our Health” website as it is rolled out across the country between now and March? It is an essential tool for carers.
	Ron’s carers were wonderful, but when his wife passed away shortly before Christmas, all his support was discontinued from the moment of her death. Now the only support he has comes from his neighbours, who help him with his shopping, and it has taken him six weeks to secure an appointment with a befriending service. We have come so far, achieving great improvements in carers’ rights and dementia awareness, but we have such a long way to go. The fact that the person being cared for has died does not mean that the carer has as well. Indeed, that may be the time when help is most important to a carer.
	Finally, I want to say something about funding. We must, absolutely must, find the correct way of funding health and social care budgets. My constituent Frank went into a care home with social care needs, and, as a self-funder, was initially charged £650 a week. After he arrived, he was diagnosed with dementia, a defined health condition, and his weekly charge has now increased to £1,200 a week owing to additional care costs. However, a state-funded person is charged only £550 a week, and there is no explanation for that. I am helping Frank’s family to explore the issue, but the fact remains that his lifetime savings and assets will be depleted in no time as they pay for his care.
	We must get on with implementing the Dilnot recommendations, particularly the cap on care costs, and we must remember that the cap does not include accommodation costs. In my view, the £75,000 that was rumoured in last week’s papers is far too high, as it will make little difference to most people. I know that budgets are tight, and that the £35,000 recommended by Dilnot would cost the taxpayer £1.7 billion, but we need to consider our priorities. I am a defender of our international
	aid efforts, but we must consider whether it was right to spend nearly £1 billion over the past five years in India, a country with its own space programme and nuclear arsenal.
	The Department for International Development needs to spend an extra £3 billion in the next two years if it is to fulfil the Government pledge of 0.7% of GDP. In cash terms, that is an increase from £7.8 billion in 2010-11 to £11 billion in 2014-15. Governments are judged on their morality, and perhaps it is now time that we recalibrated our priorities and considered spending the extra billions of pounds earmarked for aid projects abroad on funding quality care for the elderly at home.
	Benjamin Franklin famously, but rather gloomily, noted:
	“In this world nothing can be said to be certain, except death and taxes.”
	As we begin another year in the 21st century and teetering on the cusp of having a significantly ageing population, we could probably add a third item to his short list: sadly, we are likely to know someone who is suffering or has suffered from some form of dementia.
	This is an important debate, and I am very pleased that the Backbench Business Committee gave time for it. Ultimately we, as elected politicians with the power to change how we deal with those with dementia, owe it to Maurice, Ron, Frank, Nana Crouch and every constituent who suffers from, or cares for, or is a friend or family member of, someone with this awful condition, that actions really do follow the words.

Ann Clwyd: I apologise in advance for the fact that I will not be able to stay until the end of the debate. I congratulate the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate on what is a very important subject, and I thank the Backbench Business Committee for giving time for it to take place.
	First, let me emphasise that this issue is not only about money; it is about people who care about other people and about being compassionate. Since I first spoke out about compassion in nursing, my office has been overwhelmed, receiving more than 1,400 letters and e-mails from people who have experienced poor standards of care in hospitals throughout the country. Many of them are from the friends and relatives of people with dementia or other forms of progressive neurological disease. I shall read out a few extracts from this correspondence.
	The first concerns a 73-year-old man with Parkinson’s and early dementia:
	“We found him barely able to speak, sitting in a chair with no trousers, shoes or socks on. On another occasion on Christmas day afternoon we went to see him and asked him what he had eaten for lunch. The answer seemed to be ‘nothing’. We returned at lunchtime the next day to find him sitting with untouched food in front of him. He had spilt a cup of water over himself, his dentures were not in, and he was incapable of picking up a cup or food. A member of staff came to clear away the untouched food, but we stayed for an hour and fed him, piece by piece. He ate the whole meal. Other family members and friends then repeated this process on subsequent days. We were told by staff that during his stay of 37 days this quite slim man lost 3 stone in weight. We believe that the care in the ward with respect to medication and feeding was negligent.”
	Another letter states:
	“I had a similar experience when my mother spent some time in hospital. Registered blind and suffering with dementia, she was left hungry, thirsty, dirty, frightened and lonely until visiting hour. She also fell more than once and the staff were quite rude to us when we queried why she was complaining of being in pain.”
	Another letter says:
	“Myself and my family have also experienced similar treatment in the case of my late mother. She suffered from dementia and was admitted as an emergency following a fall at her care home. At the age of 82 she survived the surgical procedure but the care she later received was abysmal. We spent most of the valuable visiting times ensuring she was kept hydrated and feeding her the meals just left in front of her. After a few days we noticed she was deteriorating and despite repeatedly questioning staff, we found they were avoiding us.
	After 6 days we were informed that her deterioration was due to the fact that she had been given not only her medication, but also that of the patient who occupied the bed before her (including the contraceptive pill). My mother died shortly after discharge.”
	Finally, I want to highlight the case of an RAF veteran of the second world war who now has vascular dementia:
	“Right from the very start with his admittance to the emergency ward there has been a lack of communication and understanding of his condition and care needs. Staff in the induction ward had no comprehension of his dementia and informed me that my father was violent and disruptive. Not only has his condition deteriorated but the level of care is absent
	He has been left in a bare bed, naked in his own excrement, excrement ground into his fingernails, left without a blanket (there were no blankets available in the hospital). If for whatever reason we cannot attend he is not fed, his tablets were not given to him and left on the table.
	My father is an RAF Veteran of the Second World War. He did not serve his country or pay his taxes for 43 years of continuous employment to approach the end of his days in a filthy, poorly administered establishment.”
	I ask the Minister this: can we really call ourselves a civilised society?

Tony Baldry: I am sure everyone who listened to the right hon. Member for Cynon Valley (Ann Clwyd) describing on the radio the terrible passing of her husband will have been moved, and all the accounts she has given this afternoon are certainly appalling and unacceptable.
	I want to be concise, so I shall touch on only a few key points. My first point is on training for care assistants, a topic the right hon. Lady talked about. After I was first elected to this House some 30 years ago, several years passed before I first heard the word “Alzheimer’s”. At Christmas I would visit nursing homes in my constituency, and they were mostly full of spry widows in their 70s, but it is now impossible to get into a nursing home or residential care home in my constituency unless one is suffering from severe Alzheimer’s or dementia. As a consequence, many more people with mild dementia are now living at home in the community, being looked after by carers.
	We must greatly expand the number of care assistants in three environments: first, in hospitals. If we are to have a graduate nursing profession, we also need to ensure that caring assistants see that they have a vocation—
	that they are part of a profession and they have a set of skills. We also need to ensure that there are sufficient well-trained and motivated care assistants in nursing homes and residential care homes. For a long time nursing homes would recruit staff from overseas, very often from India, the Philippines or eastern Europe. They would train them, and then in due course those people would go and work for the national health service. Because of various changes to migration policy, however, that is no longer possible. Thirdly, we have more people with dementia and mild dementia living at home, and they also need proper care and support from care workers.
	I raised this issue with Ministers earlier in the year, and my hon. Friend the Member for North Norfolk (Norman Lamb) kindly gave me a comprehensive response:
	“We are doing lots of work with the sector to grow the workforce. We are, for example, aiming to double the number of social care apprentices to 100,000 by 2017 and expanding the current care ambassador scheme to promote a positive image of the sector.”
	I have to say that I do not get the feeling that there are currently 50,000 apprentices in the social care or care worker sector, and I do not get a sense of there being many social care apprentices in my patch. That may be because they are not promoted as such, and how does one recognise a social care apprentice or a qualified social care worker in a residential care home or hospital?
	The Minister rightly says that the Government acknowledge the importance of training and qualifications in supporting workers in their roles and in improving the quality of care services, and the Government are spending £285 million each year on training and developing the care worker work force. This may just be my view, but, again, I do not get a sense of how that is being demonstrated in outputs. I say to the Minister that we need a clearer focus on the training and development of that work force. We have made nursing a graduate profession but we must also ensure that those who are not graduate nurses—care workers in our hospitals, in our nursing homes and in the community—have a similar sense of vocation and similar training and apprenticeships. They need to be recognised as qualified care workers, and we must continue to invest in that work force.
	As the right hon. Member for Cynon Valley said, compassion is key to all of that. When my mother and her generation trained as nurses, they saw compassion as an essential part of their vocation; that was inherent in being a nurse.

Alison Seabeck: I wish to give a further anecdote. My mother trained as a nurse and she said to me that on the first day in her job she was taken by the matron to the bed and told, “This is your world. The patient, and nothing else, is what you are there to look after. I want to know exactly what is happening with each and every patient in your care.”

Tony Baldry: That was absolutely the case. There are occasions when one is just going to be out of touch on this, but hospitals are changing. When I was young, my father was a consultant and he had three wards. He was responsible for them and each had a sister, who was identifiable and accountable, as were the staff nurses. Everyone was accountable and everyone knew what was
	happening. Hospitals are changing, and in some ways medical technology means that things move a lot faster: for example, hysterectomies can now be day cases. However, people are staying longer in other parts of hospitals. As my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) said, a large number of people in hospital are also suffering from dementia, and hospitals, as well as treating the acute problems of such people, need to respond to that. They need to work out where those people go once they leave the hospital. Very often someone’s dementia is not spotted until they are in hospital.

Madeleine Moon: My mother, too, was a nurse. Sadly, at the end of her life, she ended up in hospital far too frequently, and at the very end she also had dementia. She would say that the nurses would never have been allowed to work on the wards that she worked on, because they treat conditions, not people—that is the problem. They no longer see the person in the bed; they see only the condition. Until that focus moves back to the person and their needs, and away from the condition and the diagnosis, we will not get the change we desperately need.

Tony Baldry: I entirely agree with the hon. Lady. Many of us took part in a Westminster Hall debate earlier this week on palliative and end-of-life care, when similar points were made. Sadly, all too often, what we read in our national newspapers demonstrates the desperateness that is occurring, as does the fact that the right hon. Member for Cynon Valley received 1,000 letters and e-mails in response to her tragic circumstances. This culture change in nursing needs to be reversed, because we must get compassion back into the NHS.
	The second point I wished to discuss was carers, as I co-chair the all-party group on carers. It is estimated that 670,000 people in this country have dementia and the number is due to double in the next few years. As has rightly been said, most of us will either suffer from dementia or will know someone who will be a sufferer and so will be a carer at that time. One frustration for carers is that they do not get recognised as being carers, which is extremely frustrating, particularly when they are dealing with the GP of the person they are looking after—their loved one. I intervened on the right hon. Member for Salford and Eccles (Hazel Blears) to say that part of that frustration has arisen because GPs have been slightly in denial about people with dementia, because they are not sure what to do with them when they make the diagnosis.
	However, I am pleased that the National Institute for Health and Clinical Excellence has proposed that GPs should follow three new indicators on caring for people with dementia. First, GP practices should be examined on the
	“percentage of patients with dementia with the contact details of a named carer on their record.”
	GPs must, therefore, diagnose someone with dementia because otherwise they will not know that they have a carer on their record. The second indicator is:
	“The practice has a register of patients who are carers of a person with dementia.”
	The third indicator is:
	“The percentage of carers (of a person with dementia) who have had an assessment of their health and support needs in the preceding 12 months.”
	There was criticism in some of the national press of the Prime Minister’s determination to ensure that people get a proper diagnosis of dementia if they are suffering from it, but unless people get such a diagnosis—unless GPs face up to the fact that their patients have dementia and start to care also about the carers of these people, by making sure that they get carers, assessments and so on—we will never get the qualitative and quantitative changes in how society is run to allow us to face up to a revolution, which has happened in the lifetime of many of us, in the number of people living in our society with dementia. This issue is going to grow.
	I was very impressed by what the right hon. Member for Salford and Eccles said about Salford being a dementia-friendly community; many of us must go back to our constituencies and look at the challenge dementia poses, because, in comparison, my patch is simply in the foothills of that. Over the next few years, we will all have to try to make sure that we have dementia-friendly communities.

Bob Stewart: I meet a lot of carers. I do not have the experience that some hon. Members have, but the one that struck me about so many of these carers is that they are deeply dedicated. It would be really good if they could be considered more professional. After all, we think of doctors as being in a profession, and nurses definitely have a profession. There is now a requirement for a profession of carers that is widely recognised and accepted in society. Does my hon. Friend think that that has merit?

Tony Baldry: I do. I have been trying to encourage organisations such as St John Ambulance to think about providing training for carers. Some people find that, overnight, their wife or husband has a stroke or serious fall and they find themselves as the carer, and others must deal with a gradually deteriorating situation such as dementia. Such experiences are frightening and the people involved often have to grapple with bureaucracy, the health service and so on. I am sure that if it were possible for local training to be provided for carers, a lot of these people would feel much more empowered and much more competent. The question is finding the organisations that can deliver such training.

Oliver Colvile: Does my hon. Friend agree that one key thing that also must happen is ensuring that Departments also demonstrate a lead on tackling dementia? The hon. Member for Plymouth, Moor View (Alison Seabeck) and I have been very impressed by what HMS Drake has been doing; the people there have been instrumental in Plymouth in fighting for more dementia awareness, including among Departments.

Tony Baldry: That was an extremely good point, and it was one made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) in opening this debate; every Department has a part to play in tackling dementia. Nobody would immediately have thought of the Ministry of Defence as having a role to play in tackling dementia, but every Department, as part of collective, joined-up government, needs to consider what it is doing on dementia.
	The last point I wish to make relates to research, attitudes and so on. One of the most depressing things about dementia is going into residential care homes and seeing people sitting doing nothing, staring at the wall. That is desperate. I have little fear of death—death at the worst can be eternal darkness—but I have a total fear of getting dementia. It must be a sort of living death for as long as one has it.
	A number of organisations are coming forward with ideas of how to improve, if not people’s memory, how they can cope with dementia. An organisation with a strong following in Oxfordshire is the Contented Dementia Trust. Some of its work is supported by the Royal College of Nursing, and Oliver James’s book, “Contented Dementia”, is one of the best-selling books on dementia in the UK. The Contented Dementia Trust has a particular way of helping people with their memory, because from a carers’ perspective dementia, once diagnosed, is best understood as a person’s failure to store coherently the facts of what has just happened in their life—although associated feelings are stored—whereas facts stored long before the onset of dementia remain relatively intact and potentially useful. That is why when one goes to see people with dementia they can tell in graphic detail what they did during the second world war or their childhood, but they cannot say what they had for lunch. The Contented Dementia Trust has worked out a method that, it believes, helps people with that.
	I hope that somewhere in the Department an evaluation of the various systems has been undertaken with an open mind, to consider what works. Clearly, what is required is consideration of how to stimulate people with dementia so they do not become part of the living dead. As my hon. Friend the Member for Chatham and Aylesford said, we want to ensure that those with dementia can live with dignity and can live lives of the best quality. That does not mean being stuck in a chair in a communal lounge all day between meals, perhaps getting some stimulation or perhaps not getting any. They require stimulation, help with their memory and the sorts of activities that the right hon. Member for Salford and Eccles identified as taking place in various day centres in Salford.
	We all need to share and develop the practices that work best, to ensure that people do not get proprietary about there being one correct way of dealing with dementia. We must all recognise the limits of our knowledge. One of the desperate things about dementia is that those who suffer from it cannot tell us what is happening in their lives, as if they have moved on to another planet and cannot come back and tell us what is happening to them. It is a one-way journey and they cannot help us—we can only sense whether they are happier or more contented. I hope that Ministers and officials will consider the work of organisations such as the Contented Dementia Trust with an open mind.
	The debate highlights for us all the sheer scale of the challenge over the next 20 to 50 years. It must continue to be a national priority if we are to get the compassion and care that every one of our constituents and loved ones deserves.

Madeleine Moon: It is an honour to follow the contributions we have heard in this high-level debate from every right hon. and hon. Member in the Chamber. I must declare an interest from the start, as my husband suffers from dementia.
	I worked some time ago for what was known as The Project. I, as the lead social worker, and a community mental health worker did joint assessments of people who had been diagnosed with dementia. That joint assessment was critical in ensuring that people got the right quality of care. I cannot emphasise enough how valuable and important those joint assessments were, because we saw the world from two totally different perspectives. We saw the person in the round. We saw totally different things and, when we came out, we never ceased to be amazed by the different clues and issues that we had picked up. It meant that the person received a different—and higher—quality of care.
	The hon. Member for Banbury (Sir Tony Baldry) talked about social care workers. We were very fortunate. The Project was funded by the local authority, which was the old Mid-Glamorgan county council, and the health trust, so a lot of money was put into it. We were given our own group of social care workers—we recruited and trained our own social care workers to give them an intensive knowledge and understanding of what dementia was, of the many forms of dementia and of how it would manifest itself. We also taught them about fear: the fear of carers and families of not knowing the world they were entering into. We taught them to give people information so that they knew what the future would hold, how their condition might progress and how to look for the changes and steps they were approaching, as well as where the change was coming.
	In the age of the internet, everyone can become almost an expert, but if you use the internet you can become very frightened because there is too much information and it just scares you. You need a connection to professionals who give you a feeling of being held and being walked through it at your own pace as you, as an individual carer of an individual person, go through the trauma of dementia. You also need advice about money—golly gosh, do you need that advice—about the benefits you can access and about how you are going to afford this. I have had to convert my home into a mini-hospital. A lot of my furniture has gone, and I now have a downstairs bathroom and an extension built on to the property. You need to alter your life around the person you are caring for.
	Treatment is not available for everyone, but you need to know what the experts are saying about the best way forward for you as a carer and for the person suffering from the condition. Education is essential not just for the caring community but for the professionals you interact with all the time. The worst thing carers suffer from is isolation. A number of times, when I spoke to people who were faced with dementia in a professional capacity, they told me the worst thing was the isolation. They said, “If someone has cancer, people are around all the time, but you get a diagnosis of dementia in your family and people disappear.” I found that true, too—not totally, but it is certainly there.
	There are provisions that society has put in place, and I shall talk about the advance power of attorney later, but communication skills seem to have disappeared.
	People simply do not know how to talk to people with dementia. Even when someone has quite profound dementia, there is often a way in. There is still a person in there and it is our job, as professionals, to find that person—to get in there and find some way of doing that.
	I have wonderful carers who look after my husband—they are absolutely amazing. I have two people who work only for me and they look after my husband full time. They have allowed me to carry on with my job and they have allowed my husband to carry on having a life. They take him to the theatre, they take him out for lunch and they take him out for walks. They make him laugh. We communicate with him in all sorts of ways: we draw things and we write things down. His capacity for movement is now extremely limited, but he finds a way at least to say yes or no. We still insist that he makes decisions. We do not make the decisions for him; he has to make them and he must be party to them. I have stood in front of him and said, “I am not making this decision: you will tell me. Do you want this?” And he has laughed—it has to be said that he has had that in his life for a long time, but it is still there and he still finds somewhere that way of nodding, of squeezing my hand, of holding the pen and writing on the paper. We can still get that. It drives me crazy when I see nurses and professionals who will not take the time to do that.
	I have been very fortunate. I have a fantastic GPs surgery, which won an award for the quality of the care that it has given to carers and to its patients. It makes a huge difference if you know that you can reach out to your local medical community and it will reach back to you.
	I am very fortunate that I live in Wales because the cost of care in Wales is capped. I urge the Minister to look at what Wales has done in relation to the capping of care. It makes a difference because in addition to paying for your social care needs, you also have to pay for all the other things that you might need, such as my downstairs bathroom and the changes that I have had to make to my home to make it feasible and possible for a man who can no longer walk to access the dignity that he deserves—having the chance to be clean every day, accessing the privacy of the toilet, accessing a shower so that he feels clean and fresh and feels like a human being.
	As a carer you become very reliant on the kindness of strangers. That has been true in my case. I will remain profoundly thankful for the wonderful people who have entered my life. Also, there are people out there dedicated to research, and we need their dedication and their commitment. I am very fortunate. My husband has a condition that many people do not know about; there are many dementia conditions that people do not know anything about. He has a condition called Pick’s disease. It is associated with motor neurone disease. His mother had motor neurone disease.
	The research into Pick’s disease is coming out of Manchester, University College London and Cardiff university. I am fortunate in that I have close links with Professor Huw Morris, who is the lead in Cardiff university, and I know that huge strides are being made to identify the cause of Pick’s disease. A huge family of 38 members in Gwent, who have Pick’s disease throughout their family history, have made a huge difference. Families want to be engaged in research. They want to make a
	difference. They want to know that their experience will change the future. I urge the Minister to take time to talk to families about what they think they can contribute not just to the change in care, in treatment and in people’s attitudes, but to the change in medical research. Often families want to be part of that.
	I have advance power of attorney for my husband. We were together with Dr Morris, who turned to me and asked whether I would be willing, when my husband died, for his brain to become part of the research. I said, “I’m sorry, I’m not making that decision. Steve will make that decision.” And he did. He wanted to be part of that. He wanted to contribute something. He did not want it to have been in vain. It is important that we respect the dignity and the right of the individual early on in their diagnosis to be party to simple questions like, “Are you willing, if there is an opportunity for you to give cell samples, blood tests, organs? Will you do that?” People have to be asked those questions.
	People have to be asked early on, “Do you want to know what is happening?” You have to have some quite brutal and painful conversations and it is only fair. Some hon. Members have talked about GPs not wishing to make a diagnosis. It makes me laugh when I see the figure of 43% non-diagnosed dementia cases. How can we even know it is 43%? We do not even know that. Part of the reality is that GPs need to talk to carers and ask early on, “How do you two want to play this? Do you want me always to be brutally honest with you or do you want some protection from what is happening?”
	We have to find a way of being more honest and more mature and not patronise people with dementia. We have to keep that person in their life, central to their life and central to their family for as long as it is possible. It is only then that we can hold our heads high as a decent society, as a caring and compassionate society, and make dementia something that we are no longer afraid of, but something that we fight.

Andrew Stephenson: It is a pleasure to follow the hon. Member for Bridgend (Mrs Moon). I pay tribute to her thoughtful and emotional contribution. I pay tribute also to the right hon. Members for Sutton and Cheam (Paul Burstow) and for Salford and Eccles (Hazel Blears) and to my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for securing today’s debate and for their equally thoughtful contributions.
	I shall focus my remarks on my area, Pendle, and the Lancashire Care NHS Foundation Trust’s current consultation on dementia care services across the county. In my constituency there are 1,114 people diagnosed with dementia, compared with 1,060 people in 2010. As we all know, dementia can affect anyone. It is not just an old person’s illness and we know that there are hundreds of different types of dementia, so getting the correct diagnosis is one of the biggest challenges wherever one lives in the country.
	My maternal grandmother, Mary, suffered from dementia brought on by a series of strokes. Although I was only young at the time, I remember going to visit her in Withington hospital in Manchester, where after any particularly bad period she was given six weeks’ assessment. I remember the locks on the doors to the ward, for patients’ own safety, and watching as the grandmother
	I knew and loved slipped away from us. However, for many I have met in Pendle the emotional heartbreak is even worse, with husbands and wives diagnosed with this terrible condition in their mid to late 50s, their hopes of an enjoyable retirement together dashed, their dreams shattered.
	Thankfully, the support available to dementia sufferers has improved significantly in recent years. In my constituency, although some people have raised concerns about getting the correct diagnosis from their GP, we have Memory Services, based at Maple house in Burnley general hospital, to which many people are correctly referred. With the help of Lancashire county council and the Alzheimer’s Society, East Lancashire Community Dementia Forum runs a dementia café in Colne on the fourth Thursday of every month, at the Arcadia café on Windy Bank—the importance of dementia cafés and the roles they can play has already been mentioned. Last May, I went along to the café, which runs from 2pm to 4pm, and found that providing information, advice and refreshments in a relaxed and friendly environment was a great idea for both those suffering with dementia and their carers.
	In August, I was also pleased to attend a meeting of the Alzheimer’s Society’s carers support group at Walton lane community centre in Nelson. We discussed a huge range of topics, including respite facilities, the hospital beds situation, pathways to diagnosis, the difficulty for Alzheimer sufferers of qualifying for blue badges, disabled facility grants, day care and standards of care, among many other topics. Following the meeting, I took up several of the broad points with the NHS, Lancashire county council and Pendle borough council and pursued a number of individual cases. In the same month, I also attended the East Lancashire Community Dementia Forum at Brierfield library, when the focus was on short breaks and respite care.
	Let me turn to Lancashire Care NHS Foundation Trust’s consultation on specialist dementia care services in Lancashire. The consultation opened on 3 December and runs until 25 February, with an opportunity for Pendle residents to discuss the options with representatives of Lancashire Care on Monday 28 January at Training 2000 in Nelson. Much of the information contained in the consultation document sounds very positive and few dementia sufferers or their carers would disagree with it. For example, it states that 83% of carers and people with dementia said that being able to live in their own home was very important to the person with dementia. It states that people with dementia should be moved as little as possible and, therefore, community or home care is the best option. It notes that significant progress has been made in Lancashire and that over the past year 93% of dementia care contacts were in the community, supported by specialist teams.
	However, the consultation document goes on to state that there were trends over the past three years of reduced admissions, readmissions and lengths of stay from the population in central Lancashire. If that could be replicated across the whole county, it suggests, the demand for specialist in-patient services could be expected to decrease to the point where those admitted would
	make up a much smaller group, and it is likely they would only be those detained under the Mental Health Act.
	On that basis, the trust proposes two options. Option 1 is to reduce the existing 65 specialist dementia in-patient beds across four sites in Lancashire to just 30 such beds on a single site. That single site would be in Blackpool, which could not possibly be further away from my constituency, which is in the Pennines on the Yorkshire border. Option 2 is to have 40 dementia in-patient beds on two specialist sites, one in Blackburn and one in Blackpool. Option 1 gets three pages of glowing support, whereas Option 2 gets two pages, almost a third of which points out its “Issues”—or should I say, “Disadvantages”?
	I have in my hand the consultation document, which is available in all libraries in Pendle, Ribble valley and the rest of Lancashire. It even goes so far as to have a wonderful diagram showing the two options available—Option 1 includes a nice little flower, whereas Option 2 has a mucky bit of grass. Now, call me a cynic, but I remember a similar document, ironically entitled “Meeting Patients’ Needs”, being published under the previous Government. It led to our local accident and emergency department at Burnley general hospital being downgraded, despite massive and cross-party public opposition. Although I am a massive supporter of the work done by Lancashire Care, sadly, the consultation document strikes me as very similar. When reading it, I cannot help thinking that the decision in favour of Option 1 has already been taken and that the consultation is all about getting the public to rubber stamp it.
	I, for one, will not be voting for Option 1. I will not be supporting the relocation—given the location of Blackpool, it can hardly be called centralising—of all specialist dementia in-patient beds, for a range of reasons. Primarily, the location is in no way central to the population served. It would be almost impossible for friends and family to get to without a car, and even then it would be a very long drive. Given the distance, it would be almost impossible for contact to be retained between the dementia sufferer and not only their family, but their community care team.
	We are talking about only a small number of people who would need to use these specialist in-patient beds, but the reduction from the current 65 beds to 30 beds is too much, too soon. The Blackpool option, if approved, would be up and running in 2015, and even the consultation document admits that current usage of the 65 in-patient beds across Lancashire stands at 46, or 70% utilisation. I appreciate that redirecting resources from in-patient services to community services will help to reduce dementia admissions, but with growing dementia rates and an ageing population, just 30 beds for a county the size of Lancashire seems too few. The lack of information provided on how community services will be enhanced with redirected funding also gives me great concern.
	In Lancashire, there are already at least 17,600 people aged 65 or over with dementia, and these numbers are expected to rise to more than 25,600 by 2025. We are also seeing increasing numbers under this age being correctly diagnosed with dementia. After speaking to a number of local GPs and local health commissioners in East Lancashire, I know that many of them, too, will be supporting the option of two sites with 40 beds between them rather than one with 30. I hope that other clinicians,
	people with dementia and their carers will also support this option and respond to the consultation before it closes on 25 February.

Steve Rotheram: Nothing I say will equal the power of the contribution of my hon. Friend the Member for Bridgend (Mrs Moon)—a personal account that I am sure will resonate far beyond this place. I congratulate members of the Backbench Business Committee on choosing this important topic for debate and praise the spirit in which Members in all parts of the House have engaged with issues of dementia.
	This topic is particularly close to my heart. Anyone who has watched helplessly as a loved one battles with dementia, often forgetting your name and your relationship to them, knows the agony that is felt and the feeling of hopelessness. As people will know from their own experiences, it is all the more painful when it is a close relative, especially when, as in my own case, it is your own mother who is suffering from this cruel condition. Words cannot begin to describe the heartbreak of seeing a vacant expression etched across the face of a person once so full of vibrancy as they struggle to fathom what is going on or why they feel in such a strange state of confusion.
	As I was coming to terms with my own mum’s condition and the fact that this condition had stolen her mind, I was left with the same unanswered questions that thousands are now asking. Why was she not diagnosed earlier? Why did not my brothers, sisters and I recognise the signs earlier? Why was there not better advice on the different treatments available? Why was the support that she received from relevant authorities at best patchy but at worst totally inadequate? My mum was not lucky enough to have had the expert advice, care or treatment that is available today when she died.
	We can ill afford to kick social care into the long grass and avoid the realities of an ageing population that will undoubtedly present challenges for dementia health care professionals in future. With no new treatments having been released on to the market for 10 years, it was right for the Prime Minister to guarantee money for research by the Alzheimer’s Society following the work of the national dementia strategy presented to this place by my right hon. Friend the Member for Kingston upon Hull West and Hessle (Alan Johnson) and rightly highlighted by the right hon. Member for Sutton and Cheam (Paul Burstow) in his opening speech.
	Today I want to talk about ways in which the city of Liverpool is sourcing innovative treatments for dementia. It is estimated that the number of people in Liverpool with dementia will rise from 4,382 in 2010 to 5,209 in 2021, ranking the city third highest in the north-west. Alarmingly, of those in Liverpool who were suffering from dementia in 2010, only 51% had actually received a diagnosis. That means that almost half of our city’s dementia sufferers were unknowingly living with this debilitating condition. That is why in our city we have decided to tackle dementia head on as part of Liverpool’s decade of health and well-being, which was officially launched in 2010.
	Although most hospitals treat dementia patients by using a group of medications called—I wrote this down earlier thinking it would be easy to deliver in Parliament—
	cholinesterase inhibitors or the drugs donepezil and memantine, in Liverpool we have tried and successfully tested the use of art and culture in dementia treatment. Our non-pharmaceutical approach to dementia treatment is a unique model and one that other cites and regions across the country may wish to follow as they cope with increasing demand on decreasing resources.
	After Liverpool’s highly successful year as the European capital of culture in 2008, we worked with international partners to collate evidence that proved that art and culture have the potential to improve well-being and have a positive role to play in mental health care.
	Museums and art galleries are the gatekeepers to history. They play a crucial role in society, which is to protect and preserve what has gone before so that we can learn for the future. During our evidence-gathering we received a report entitled, “Museums of the Mind”, which encouraged museums to think about the role that they could play in their local communities with regard to mental health issues more broadly. National Museums Liverpool recognised the growing problem with dementia in our city and decided that it wanted to work specifically on the issue, drawing on the expertise of the Museum of Modern Art in New York, which ran an internationally acclaimed programme where gallery staff engaged with individuals living with dementia. And so House of Memories was born on Merseyside.
	The scheme is training and delivering programmes built around the objects, archives and stories held in the Museum of Liverpool. The idea is to provide social and health-care staff with new skills and resources to share with people living with dementia and to promote and enhance their well-being and quality of life as a potential alternative to medication.
	As the total cost of dementia to the UK economy rose to a staggering £23 billion in 2012—a figure that is unsustainable in an age of austerity that has been extended to 2017 by this Government—the work of National Museums Liverpool is a blueprint for other cities and regions to follow as we look to improve dementia care and reduce the cost to the NHS. As always, however, funding pressures are endangering the future of such innovative programmes. I believe that Liverpool’s non-pharmaceutical approach can and should be adopted by other cities and regions in the United Kingdom, thereby saving millions of pounds for the NHS.
	One of the most worrying aspects of dementia care is the fact that public awareness of dementia remains scandalously low and that we as a society almost ignorantly allow dementia to be excused as nothing more than the ravages of old age. Liverpool therefore began by drawing together a partnership of major businesses from a variety of sectors that went beyond health care professionals and included many organisations from our thriving cultural sector. This meant that Tate Liverpool, the Bluecoat and the Liverpool biennial festival worked alongside Liverpool universities, Age Concern, BBC Radio Merseyside, the police and fire services and charities such as Dare to Care and Crossroads Care.
	Last year the decision was taken by Liverpool Hope university, in conjunction with the chief executives and managers of Liverpool city council, the Alzheimer’s Society, NHS Merseyside, Mersey Care NHS Trust, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool Community Health NHS Trust
	and Age Concern Liverpool and Sefton, to dedicate 2013 as the year of dementia, as part of Liverpool’s decade of health and well-being.
	Liverpool’s ability to make a difference for dementia patients would not be possible were it not for the excellent work of the Alzheimer’s Society. When I was the lord mayor of Liverpool, I chose the Alzheimer’s Society as one of my five sponsored charities and was extremely proud to award it with its largest ever cheque at that time of £115,000, in recognition of the vital work it does in our city.

Hazel Blears: My hon. Friend is making an incredibly innovative speech about developments in Liverpool. He mentioned the Alzheimer’s Society. Does he agree that without the drive, commitment and imagination of the Alzheimer’s Society, we would not be seeing the current progress and momentum?

Steve Rotheram: My right hon. Friend is right. It is not until somebody who is close to you needs the support of services such as those provided by the Alzheimer’s Society that you understand just how good and supportive they are. When I gave the Alzheimer’s Society that money as lord mayor, I also gave money to Alder Hey children’s hospital. It is much easier to raise money for sick children than for people whom some others see as just getting a bit old and going a bit loopy. That was one of the accusations against my mother. People said, “She’ll be okay, she’s just losing it a bit!” That is not the same thing as dementia. That is why it is important to raise awareness of dementia and why it is fantastic to see that this debate has been so well subscribed to.
	In Liverpool, the Alzheimer’s Society facilitates services for dementia patients that use art and culture to assist sufferers and their carers in better understanding the condition. For instance, dance therapy is offered which invites
	“movers and shakers of all ages to come and enjoy themselves and shake off the shackles of dementia”.
	Additionally, multi-sensory stimulation is provided through art therapy and music therapy, which stimulate emotional, social and cognitive connections between dementia patients, their carers and their families. There is also a memory clinic, like those mentioned by the hon. Member for Chatham and Aylesford (Tracey Crouch), in Walton in my constituency, which is a weekly meeting that offers support, advice and guidance to sufferers and their loved ones.
	In other words, Liverpool is dedicated to a creative approach to stimulate rather than medicate dementia patients wherever possible, and to prolong their quality of life as much as is possible. I hope that Members will use the example set by Liverpool to encourage similar partnerships across the cities, towns and communities in their regions. A recent participant in National Museums Liverpool’s House of Memories scheme recalled a lesson that they had learned as a member of the programme, which MPs may wish to consider on leaving this debate:
	“The House of Memories scheme has enabled me to come into the world of the person living with dementia, rather than expect them to enter mine. After today, my approach will be very different.”
	By changing the emphasis of dementia treatment to a more pioneering approach such as the one successfully tried and tested in Liverpool, we can begin to change the stigma of dementia and improve patients’ lives. In doing so, we can aim to educate sufferers about the advantages of owning up to the problems that they face and improve the rates of early diagnosis, while at the same time ensuring that the wider public are more aware of the early signs of the condition. Only then can we, as a society, forgive our collective ignorance and really begin to support our patients and dedicated carers in tackling this country’s fastest growing health priority.

Glyn Davies: Like others, I pay tribute to those who secured today’s debate: the Backbench Business Committee, the right hon. Members for Sutton and Cheam (Paul Burstow) and for Salford and Eccles (Hazel Blears), and my hon. Friend Member for Chatham and Aylesford (Tracey Crouch). The debate is about a hugely important subject of which many Members will have personal experience.
	Many of us are aware of the scale of the issue: dementia will affect 1.7 million people by the middle of the century, probably double the figure now. It is probably one of the biggest challenges that this Government—and future Governments—will have to face, and will be particularly important in Wales where the percentage of people aged over 65 is higher than anywhere else in the United Kingdom.
	The right hon. Member for Salford and Eccles paid tribute to the commitment of the Prime Minister, who launched the dementia strategy last year, and there is a commitment to increased spending on research. That is not anywhere near enough, however, and I am certain that in future our commitment to tackling dementia will have to be greatly increased.
	I want to make five or six brief points, some of which are from a Welsh perspective. As we know, the matter is devolved, but as the right hon. Member for Sutton and Cheam said, where there are differences between the parts of the United Kingdom, lessons can be learned from one Administration by another, and devolution can be a sort of test bed. Different attitudes are developing in Wales and we may be able to learn things from that.
	The issue I will mention first because it is so important is early diagnosis. Levels of diagnosis in Wales are particularly low—only 37.5% of people with dementia are diagnosed, which is far lower than in other parts of the United Kingdom—and of course access to new drugs and treatments is simply not available to people who have not been diagnosed with dementia.
	Many of us—probably most who will speak in this debate—have personal experience of the issue, and one thing that is common to most is that we do not realise when someone is suffering from dementia. We may think there is a degree of slowness but we do not realise what they are suffering from. The second time it happens in a family people respond much better because they know pretty much what to expect. Those suffering from dementia can be crafty because they are desperate to hide their condition; in some ways there is embarrassment about it and they do not want people to know. Without experience, dementia is difficult to identify, so early diagnosis must be an aim for anyone concerned with dealing with it.
	The second issue, which was touched on earlier, is training for nurses. There is a general issue at the moment about basic care in the health service—that was touched on last Tuesday during the debate on the Liverpool care pathway, and the right hon. Member for Cynon Valley (Ann Clwyd) also mentioned it. To my mind, such training is particularly important for people in the acute health services, many of whom are elderly. Many people go into hospital because they have had a fall although they are also suffering from dementia. The level of disruption and disturbance caused when they go into hospital can completely disorientate sufferers, and the rapid onset of serious dementia is much quicker and more radical in such a situation. It is important that those working in acute health services are trained in identifying and dealing with the dementia aspect of illness, as well as with the actual condition such as a broken hip or bone.
	My third point is about Parkinson’s disease. I am involved in my local Parkinson’s disease charity. I do not know whether the trauma of Parkinson’s disease brings on dementia or whether it is the other way round, but we know that people suffer from Parkinson’s disease for quite a long time before it becomes publicly apparent. Many people will go into hospital and seem to suffer from dementia without anyone realising that they are suffering from Parkinson’s. That disease may come on more quickly—the trauma may cause it—so it is vital that in hospitals and care situations patients’ conditions are regularly assessed to see whether they are suffering from Parkinson’s disease, and that they are not just dismissed as a dementia patient while another illness is completely ignored.
	I touched earlier on the liaison between Governments in Wales and England but that may apply to other Administrations as well. Without making any negative political point, there is a difference in approach. The Welsh Government are much more suspicious of the private sector than the UK Government—that applies particularly to the provision of social care. The Welsh Government’s view is that social care is delivered far better by the public sector, but, generally speaking, social care is delivered by the private sector.
	The relevant Committee has considered that, and there is a very good chance that there will be new, different approaches in Wales—they could be based on co-operatives or they could be community based. They might work in an urban situation, but it is important that the Government in Westminster and the Government in Wales are aware of what is happening, and that they learn about good practice and what might work.
	My final point—perhaps I will be the only hon. Member to make it in the debate—is on the Welsh language. Many who are elderly and frail in Wales spoke only Welsh until they were seven, eight or nine years old—in those days, people became involved in education at that age. Today, people often go to monolingual, Welsh language schools. Up until the ages of seven or eight, that is the only language they speak, and we know that people suffering advanced dementia revert to their childhood language.
	I visited an esteemed former Member of the House and House of Lords who suffers from dementia. Towards the end of his life, he was able to speak only Welsh. Previously, he had been able to speak English, but at that stage, he could speak only Welsh. I acted as an
	interpreter. That is important in care homes in Wales. Such people are suddenly completely isolated. Very often, they cannot speak even to their spouse.

Madeleine Moon: I rise only to confirm exactly what the hon. Gentleman says. I worked in specialist rehabilitation in Gorseinon, which is part of Swansea where the Welsh language is much more prevalent. Families would come in, and often, I would say to them, “Speak to your family member,” which was usually a mum or a dad, “in Welsh, and tell me what you want.” It is true that going back to the language of childhood often makes communication continue for much longer than speaking the adoptive language. However, that has implications in our multicultural society across our ethnic communities, and we must bear it in mind. No matter where a person comes from or whatever their culture, we must be able to provide communication in their language of childhood.

Glyn Davies: I thank the hon. Lady. I was going to expand my point on the Welsh language into the impact on people who speak other languages, as so many do. People’s reversion to the language they spoke as children came as a huge shock to me. I found that the great parliamentarian I went to see was unable to communicate with his wife because she did not speak that language—it was the only one he could speak. It was a strange experience. In that home, nobody could speak Welsh, which was a tragedy. Hon. Members often discuss and debate where the Welsh language should be available, but it should be available in care homes in Wales, and particularly in ones that have a dementia wing. Having somebody who can speak Welsh is important.
	A spin-off point from that is on people who have moved away from Wales—the diaspora. They could fall ill in another part of the country. Traditionally, they would come home to where they are originally from and continue to see family and friends, but they could finish up not being able to communicate with people where they live. There is a case for work between the Governments in England and Wales—the availability of the language of youth applies to other parts of the UK—on helping to repatriate people to deal with the problem. Not being able to communicate with anybody, including family, must be incredibly difficult.
	Dementia is a huge issue and there are many aspects to it. I hope I have touched on one—language—and one or two others that have not been covered by other hon. Members.

Debbie Abrahams: I congratulate right hon. and hon. Members on securing this important debate. The speeches have been moving and thoughtful. Today has demonstrated the best of Parliament, with MPs coming together and contributing to how we can resolve the dreadful issues around dementia. I am grateful to have the opportunity to speak today as, in addition to representing a constituency in Oldham where, in 2010, 2,318 people were diagnosed with Alzheimer’s, the most common form of dementia, I have personal experience of being the daughter and carer of someone with Alzheimer’s. I would like to bring that personal experience to the debate.
	In September last year, my mother died of Alzheimer’s. She was only 74. In 1992, she remarried and moved to the US, and it was there, 10 years later, that she was diagnosed with the disease.

Anna Soubry: Does the hon. Lady agree that those who have experienced these sorts of incidences first hand can bring to debates a remarkable amount of insight to, and understanding of, these conditions? Does she also agree that it is important for us all, especially Government, to listen to those experiences, so that we might be able to learn from them?

Debbie Abrahams: I am very grateful to the hon. Lady for her intervention. I totally agree.
	My mother was 64 when she was diagnosed and was still working. She told me that she stood in the middle of the office where she worked and could not remember why she was there. Not only did she find it abhorrent to be diagnosed with this devastating degenerative disease, but the financial consequences of having to give up her job were a severe blow too.
	To watch her decline was nothing short of heartbreaking. Two years after she was diagnosed, the penny dropped for me when we went to a restaurant and she was given a menu. As my hon. Friend the Member for Bridgend (Mrs Moon) said, it is so important to make sure that people with dementia still have as much control over their lives as possible. She looked at the menu, and kept on looking at it again and again. She did not understand what she had to do with the menu—one of the practical consequences of the disease. She became a different person—not a better or a worse person, just different. As much as I loved my old Mum, I loved my new Mum too. I will remember until the day I die the first time she did not recognise me, which was about four years after she was diagnosed. She was very distressed, because she knew that I was someone of importance to her, but she did not know her relationship to me. Needless to say, the pain I felt was—well, I cannot explain.
	My mother went from being a brilliant, vivacious, caring woman—a woman who invented the term social justice before it entered the lexicon—to a woman who gradually lost her ability to communicate, feed or toilet herself. In the last year of her life, she became wheelchair-bound and in her final month completely bedridden. She was unable even to lift her head and the end came shortly after she lost her ability to swallow.
	In many ways we were very lucky because my mother remained physically well for so long, but also because up until the last year of her life she seemed relatively content, smiling and laughing, particularly around animals and children, as she had always been. I agree with my hon. Friend the Member for Bridgend that people with dementia understand far more and we have to find ways of communicating with them. My hon. Friend the Member for Liverpool, Walton (Steve Rotheram) also talked about different ways of engaging with people with dementia.
	Unfortunately, the care arrangements in the final year of Mum’s life, and ultimately the circumstances around her death, can only be described as shameful. She was in the US at this stage. After much consideration,
	I have decided to talk about this now because dementia has such consequences for everybody in this country and across the world. Up until 2011, my stepfather, who is 81, had been Mum’s main carer, although he paid for a carer to help Mum get up in the morning in their New York home. I used to provide respite for him during my leave, but the physical and emotional toil and strain was taking its toll and he began looking for caring support.
	That support was offered by an acquaintance of his who offered to provide care for my mum for an agreed fee. Over a few months, unbeknown to me or my family, the new carer moved into the house, got access to their finances, sold their home and drove them more than 800 miles away from my stepfather’s family in New York to South Carolina, where they knew nobody. Within a week of the move, my mum was admitted to hospital and we were told that she had days to live. When I arrived, I was shocked to see their circumstances: they had moved from a comfortable family home to what can only be described as a hovel, and the female carer had gained almost complete control over their lives. I alerted Adult Protective Services in South Carolina about my concerns for my mum’s and stepdad’s welfare on 24 August. After week’s of chasing it, including through the Governor’s office, I got a reply on 19 October saying that it deemed my father, whom it had never even met, to be competent and would not be taking it any further. Unfortunately, my mum had died by then.
	My mum’s story is not unique. The stages in her decline and her and my family’s experiences are being replicated in this country and across the world. My story happened in the US and, based on my discussions with adult protection teams in this country, I am confident that the casual response from Adult Protective Services in South Carolina would not be reflected here, but there are still lessons to learn. We must ensure that the regime we set up around carers protects people with dementia from exploitation. I fear that, as has happened in other areas of the world where personal health budgets and individual social budgets have been introduced, some of the moves towards personal budgets here will lead to fraud and exploitation.
	I could speak for hours about what I believe we need to do, but I would like to raise just a few points. First, as individuals, families and communities, we need to be more aware of the disease, as has already been mentioned. The odds are that most people will be affected by this disease. It might not be themselves or their family, but it might be their friends or neighbours, and we need to do more to protect ourselves against the disease. The Alzheimer’s Society is a wonderful resource, as we just heard, for information and support. We need to keep active and healthy, not smoke and so on—all the messages we know so well.
	We need to do more on research. I fully support and recognise what the Government are doing in increasing research funding—it is such an important area—but the moneys being dedicated are paltry next to the scale of the problem. We need to address that. I was pleased to hear what my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said about the Wellcome Trust funding, and I hope that we can pursue that more.
	Finally, we need to do far more at health and care service levels. As I said, 2,318 people in Oldham were diagnosed with Alzheimer’s in 2010 and more than 800,000 across the country. By 2020, it is estimated that
	this number will have increased to 1 million. Most worryingly, however, as we have already heard, that is an underestimate and is probably half the actual scale of the disease. Apart from the human cost, £23 billion is spent treating and caring for Alzheimer’s patients every year. This will rise to £27 billion by 2018 and will continue to increase. There is already a care crisis in this country, with cuts to adult care services in the NHS, and this will only get worse, not better. Care services are already at breaking point. How will families cope with Alzheimer’s? It is a ticking time bomb. I urge the Government and the Opposition to work together to reach a cross-party consensus on how we fund and deliver national care service, and that must include the Treasury teams. We cannot afford to kick this issue into the long grass any longer.

Oliver Colvile: My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) hit the nail on the head when she made the point that everyone knows somebody who has been affected by dementia or some form of Alzheimer’s. I have a stepmother who is very elderly now—she is 93 and is in a home. The last time I went to see her, she was woken up and she looked at me, squawked and went straight back to sleep again. That is very sad—it is incredibly sad—for one simple reason. This was a woman who got a degree at Oxford in 1938, at a time when women did not get degrees. She then became an interpreter at Bletchley park during the war and played a significant part in defending our country from Nazi oppression. For her to be in that position now is very worrying and concerning for all of us. I very much hope that she continues to have an acceptable life, and I am delighted that everyone there is most certainly going to be helpful.
	I pay tribute to the hon. Members for Bridgend (Mrs Moon) and for Oldham East and Saddleworth (Debbie Abrahams), who must have found it very difficult to talk about their personal lives and experiences. I commend them both for being able to do so in this environment and for getting through it. May I also say what an honour it is to share a platform in this debate with the hon. Member for Plymouth, Moor View (Alison Seabeck)? I suspect that, between us, we will find ourselves repeating each other somewhat, although I am in the fortunate position of going first.
	The issue of social care is becoming increasingly important. There has been an enormous amount of press attention on how people are cared for in the latter years of their lives. However harrowing the stories may be, they provide us with an opportunity to speak about social care and lessen the stigma that surrounds death and dying. Dementia is already a significant issue and a growing concern that should not be ignored.
	I am delighted to say that I represent a constituency in a part of a city that has a really good reputation on dementia, especially through the university. An enormous amount of research is done; indeed, I am for ever getting telephone calls from Ian Sheriff—for whom I have an enormous amount of time—who rings me up and gives me advice on how we should handle this issue. However, I was surprised to find out that there are currently more clinical trials into hay fever than into
	some common forms of dementia. When I heard that our mutual friend the Health Secretary had announced that spending on dementia research would receive a £22 million cash injection, I was therefore incredibly grateful. More funding will most certainly need to be made available to excellent bodies around the country such as the Alzheimer’s Society and to universities such as Plymouth.
	Plymouth university conducts a great deal of research into dementia and this policy area. In September the university held a very good conference, which it asked the Prime Minister to attend. Unfortunately he could not come, but we will see whether we can have another go later. Any help that the Minister, my hon. Friend the Member for North Norfolk (Norman Lamb), can give to encourage the Prime Minister to come and participate in the dementia conference would be helpful. Indeed, his lead in the dementia challenge has given the whole thing an impetus. The university also does a lot of work on community engagement and raising awareness. Indeed, shortly after Christmas I went to Stoke Damerel community college, which has done a lot of work on encouraging youngsters to become more involved in community engagement with dementia. May I also pay tribute again to HMS Drake, which is taking a big lead on dementia and ensuring that this happens elsewhere in the Ministry of Defence?
	In Plymouth there are around 3,200 individuals with dementia. That figure is forecast to rise by 35% in the next 10 years, but this is just the beginning. The diagnosis rate is 39%, which it is estimated will increase by 27% before 2021. That means that a large number of people in my constituency do not have access to the care and support they need on a daily basis. The new NHS mandate commits to drive up diagnosis, which can only be a good thing for both sufferers and their families. I know that the Government want the clinical commissioning groups and the NHS Commissioning Board to work together on that aim, and I would welcome more information from my hon. Friend the Minister on what plans are in place to ensure that that happens, so that the lives of sufferers and their carers can improve.
	GPs are on the front line when it comes to driving up diagnosis rates. They express their concern about mistaking the symptoms of dementia for old age. In some cases, they do not make a diagnosis of dementia because they feel that to do so is futile. I am aware that the Department of Health has put forward the case for a reward through proactive case finding, which is due to be consulted on this year. Is there a timetable for that consultation to begin? The sooner we start to diagnose those in need, the sooner we can start to help them.
	Earlier this week, I participated in a debate on the Liverpool care pathway. We had an interesting discussion, and real concerns were raised. I told a story about a constituent who came to see me about her father. It had been decided to put him on the Liverpool care pathway, but the family were concerned because they knew nothing about that until they were told about it by one of the car park attendants at the hospital. The process was supposed to last for two days, but it went on for 12 days, and the family were very concerned about that. Will my hon. Friend the Minister have another look at that issue, just to make sure that such cases have been included in the review of the LCP?
	A number of excellent facilities exist around the country, especially in Plymouth, and I want to pay tribute to St Luke’s hospice, and to the hospice movement in general, for doing a tremendous job. They are certainly appropriate places for people to spend the last few days of their lives. Given that the report on Stafford hospital is to be released shortly, however, it is clear that dementia sufferers often do not have the dignified death that we would expect for them. I am aware that we are all mortal, although I have wondered whether God might make an exception in my case, and whether I might be here for ever and a day. I know that that is not going to happen, however.
	It is important to ensure that, when dementia sufferers die, they are able to do so with dignity and without pain. The more work that we can do to ensure that that happens, the better. Vulnerable people need to be properly looked after, as do their carers. We need to ensure that we talk to the relatives as well, to ensure that they understand the processes involved. None of us—politicians or anyone else—likes to be ambushed, and it is important to help those family members to work their way through their suffering as well.

Neil Parish: My hon. Friend is making some good points. Those who care for dementia sufferers need respite care, but we do not always provide for that as well as we should. I am keen to see more respite care being provided for those who care for people with dementia.

Oliver Colvile: I agree with my hon. Friend. This is also about the families, who have to deal with dementia on a daily basis.
	Given the appalling events at Stafford hospital, appropriate checks and balances must be put in place to ensure that people with dementia are given the proper quality of care in all hospitals. Further, it should become standard practice that the demands of someone with dementia should be listened to. It is incredibly important that we get better at listening to what they, and their families, are saying. Dementia is a complex illness, and it is often difficult to assess its onset. Whenever possible, however, conversations should be held with the individual and their loved ones about what is happening and the process that is involved. Such conversations would be useful in helping the family through the process.
	Dementia is now one of the top five causes of death in the United Kingdom, and it is disappointing that the health and wellbeing boards are being a little slow to consider people’s needs. About 800,000 people in the UK have dementia, and that number is going to go up. It is said that more pressure is being put on the national health service. I do not think that is right. I think that we are making enormous strides in order to deliver better health care for our elderly. It is because we want to do more that our national health service is facing increasing levels of challenge.
	For those with dementia, the changes to long-term care are crucial. I am delighted that the Government are looking at trying to take forward the Dilnot report, to which I made my own submission—I have a copy here or I could e-mail it to the Minister. That report must be viewed as a blueprint for how to go forward.
	There has been increasing debate with the Treasury since the 1940s. Let me remind everyone of what happened in 1947 when the national health service, of which we are all very supportive and proud, was first set up. The other half of the equation was long-term social care. Over the last 10 or 15 years since I was a candidate for Plymouth, Sutton as it then was—it is now Plymouth, Sutton and Devonport—I have spoken about the divorce of social care from the national health service. If I have a heart attack or have cancer, I will have to deal with it one way, but if I have Alzheimer’s, Parkinson’s or dementia, it will be considered to some extent as being a separate challenge. I believe that we need to bring the two much closer together.
	I have some concerns about using insurance. Every time I have had to make claims—on my car insurance, for example—I have always had some difficulty with my provider. We need to look at that, but we need to ensure that people do not see all their savings just disappearing into a black hole. That is something that we need to deal with as a country. There is a danger that the amount of money individuals are asked to pay for their care will remain far too high. We cannot hide from that in our ageing society.
	At the beginning of my time in the House, I wrote a paper on the strategic defence and security review, in which I said that there were two important matters of which we needed to take notice. The first was that more money needed to be put into defence—I continue to say that—but the second was that we should devote more money to long-term care for the elderly. That was my No. 2 priority; it has to be incredibly important.
	I welcome the Government’s decision to take on the global health challenge—a priority after years of neglecting this growing problem. I welcome the Prime Minister’s commitment and the leadership and extra support he has provided for people with dementia in carrying out their everyday tasks. That shows a shift in the wish to combat the stigma that surrounds dementia and to achieve greater awareness of the illness. We need to learn, too, from the ethnic minority communities that tend to work much more closely together with their families in providing care.

Robin Walker: My hon. Friend is making an excellent speech. I want to support his point about the Prime Minister and the issue of stigma with a quote from Professor Dawn Brooker, who helped found the Association for Dementia Studies at the university of Worcester. She said:
	“Stigma and fear are the biggest enemies of achieving”
	progress on dementia. She continued:
	“What makes the PM Challenge so important is that it says very clearly that he is not ashamed or fearful of standing up and talking about dementia. If he can do this then it makes it safe for every politician and leader to do the same.”
	I believe Members of all parties have shown the same courage in taking this issue forward today.

Oliver Colvile: My hon. Friend is absolutely right, and the same issue applies to mental health, about which I have also spoken at some length in this place. We need to break down these taboos and move on.
	I very much hope I have not taken all the thunder of the hon. Member for Plymouth, Moor View. There must be joint responsibility by Government health boards
	and staff in the health service to ensure that the diagnosis of dementia and the quality of care improve significantly. That way, we can show that we are on track for the future.

Barbara Keeley: It is a pleasure to speak in this Back-Bench debate on dementia. I congratulate my right hon. Friend the Member for Salford and Eccles (Hazel Blears), the right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing the debate and on their excellent contributions. I join others in saying how much I appreciated the moving and personal contributions from right hon. and hon. Members this afternoon. It must have been very difficult for them to talk about their personal experiences, but they did it very well.
	My right hon. Friend the Member for Salford and Eccles has worked unstintingly on this issue, locally and nationally. Like her, I want Salford to become a dementia-friendly community. I share her pride that Salford contains one of the 10 national demonstration sites, in the Humphrey Booth centre in Swinton, which has its own day centre, the Poppy centre. I also agree with her that more needs to be done to improve our community services, to reduce hospital stays, to increase rates of diagnosis of the condition—many Members have mentioned that today—and to end the stigma that is so often associated with it.
	I want to talk specifically about carers for people with dementia. As others have pointed out, about 10% of our 6.5 million carers are caring for a person with dementia, which means that at least 2,000 of our 22,000 carers in Salford must be in that position. The nature of the symptoms of dementia clearly makes providing such care particularly difficult. People with dementia can grow agitated, and they may wander at night and call out when asleep, which means that the carers themselves get little sleep. The personal care needs of those with dementia can be very great, as has also been mentioned today. Many people are performing a caring function for more than 100 hours a week. As we have heard, family members caring for a person with dementia must cope with personality change and loss of memory. Those very serious changes cause them to suffer feelings of grief and loss, similar to the experience of bereavement but before bereavement.
	Dealing with that heavy caring work load also means that shortcomings in the provision of appropriate care services will be keenly felt. If carers do not have confidence in the quality or appropriateness of care, they will not have the confidence to take the respite breaks they so badly need. In 2007, when I was parliamentary champion for carers week, I visited some local carers and talked to them about our local services. One of them, a remarkable woman, was caring for her husband, who had vascular dementia. When she and I introduced ourselves, she told me “I am his nurse.” That was the change that had come about in her relationship with her husband.
	The woman also told me how impossible it was proving to be to find adequate respite care locally. On one occasion, a week’s respite care had been arranged, with her husband staying at a local nursing home. Owing to a catalogue of problems at the start of the
	week, she then had no confidence that the home would manage her husband’s care properly, and she began to visit him there every day. By Wednesday, when family members found him lying unshaven in a soiled bed, she said that enough was enough, and brought him home. The end result of all her worries during those four days was that she developed eczema and had to visit her GP. That was her one week’s respite care.
	One aspect of that woman’s life that she did praise was the support given by Crossroads Care, which is now part of the Carers Trust. Twice a week it provided two hours of respite care that she trusted. During one two-hour slot, she did her shopping at the local supermarket; during the other, she went to play bingo. When I asked her what we politicians could do for her and what changes she wanted to see, she told me that she wanted regulators who inspected care or nursing homes to ask carers for feedback about their experiences, and that, for herself, she wanted occasionally to have respite care lasting longer than two hours, so that she could wander around the shops rather than racing to get back home.
	That was more than five years ago. I wish I could record that the situation for carers for people with dementia had improved radically in that time, but, given the increasing number of people with dementia and the crisis in the funding of social care—which has been touched on by several Members—the amount of respite care per individual carer cannot be stepped up dramatically, which is a pity. Crossroads Care told me that in 2008 it had provided 9,000 hours of respite care for 398 carers. This year it will provide some 13,800 hours of respite care for 567 carers. As I said earlier, we probably have some 2,000 carers for people with dementia, so the support is reaching only just over a quarter of the people who might need it.
	The Health Committee’s recent report on our accountability hearing with the Care Quality Commission concluded that the regulator inspecting our care homes still did not have the confidence of carers, families and residents. It recommended that feedback from carers and other members of the public should start to be regarded by the commission as “free intelligence”, and that the regulator should act swiftly when complaints were brought to light.
	In 2007 I introduced a ten-minute rule Bill, the Carers (Identification and Support) Bill, which required health bodies
	“to identify patients who are carers or who have a carer”
	and take steps to promote their health. I have introduced similar Bills subsequently, including, on 7 September this year, the Social Care (Local Sufficiency) and Identification of Carers Bill. I am still convinced of the need for health bodies—hospitals or, in primary care, GPs and their teams—to identify carers and ensure they receive information, advice and health checks. That would help avoid the isolation carers feel, which my hon. Friend the Member for Bridgend (Mrs Moon) talked about. They would be connected with professionals and other carers.

Martin Horwood: I agree with what the hon. Lady is saying, and, indeed, we might mention institutions such as the National Institute for Health and Clinical Excellence in this context. When I worked for the Alzheimer’s Society, we had the experience of trying to persuade NICE that evidence from carers
	about some quite difficult-to-research things such as behaviour and daily living skills was valid evidence when collected systematically and at scale—and, indeed, just as valid in its way as the evidence from things such as clinical trials and cognitive scales?

Barbara Keeley: Yes, and probably more so. The key concept here is that of the expert carer. Reference has been made to the professional carer, but I think expert carer is the right term. I shall talk about NICE shortly.
	My Bill stated that health bodies should promote and safeguard the health and well-being of carers. They should ensure that effective procedures exist to identify patients who are carers or who are about to become carers, and ensure systems are in place to make sure that carers receive information and advice and that general medical services are rendered to patients who are carers. The reason for that is that carers will ignore their own health. They will entirely put the person they are caring for first, and put their own health to the back of the queue.
	I was interested to see that this week NICE started a consultation on the topics prioritised for development in the quality and outcomes framework for 2014-15. The hon. Member for Banbury (Sir Tony Baldry) discussed the three indicators, the first of which is:
	“The percentage of patients with dementia with the contact details of a named carer on their record.”
	The second indicator is:
	“The practice has a register of patients who are carers of a person with dementia.”
	The third indicator is:
	“The percentage of carers (of a person with dementia) who have had an assessment of their health and support needs in the preceding 12 months.”
	I would have welcomed this development, as the identification and support of carers is a crucial issue, but I have some comments to make on the indicators. I doubt whether the QOF is the best way to achieve progress, and in some respects this issue is more a higher priority. We currently give three QOF points to GP practices that keep a register of carers, but they could, in fact, have a small and static register of carers that they did not consult on, improve and develop. They would still get three points, however. The task of properly identifying carers and making sure they get the advice and support and the health checks they need is certainly worth more than the £400 that these three QOF points averages out as being worth. Is that what we think these tasks are worth? They surely must be worth more than that.
	I have taken advice on this matter and I suggest that a better solution would be to tier the indicator payment based on the percentage of carers identified. Sufficient QOF points should be given properly to recognise the achievement of the task as well. It will take a number of people quite a bit of time to perform it, particularly if it is performed at the higher levels of achievement. Carers trusts tell me it is hard to find GP practices where more than 3% of carers are identified. The figure should be about 10%.
	I fully support the indicator measuring the percentage of carers who have had an assessment of their health and support needs in the preceding 12 months, as that is a very important development, but why does it cover
	only carers of people with dementia? In my constituency there are carers of people who have had a stroke who have a very heavy, and very similar, work load to carers of those with dementia. It would be better to specify a small range of long-term conditions that lead to carers having a heavy caring work load, and they should be identified and receive assessments.
	I want to record my thanks to organisations in Salford and elsewhere that do a wonderful job in supporting carers of people with dementia. I have mentioned the Humphrey Booth centre, and Age UK in Salford has a dementia support service. Those services are very important. They provide buddy cafés that support both people with dementia with activities and carers with respite. A buddy café lasts for five hours. That is a welcome period of respite for carers. There is a drop-in café at the HBC as well as a carers training programme, and it offers vital information, advice and advocacy services. It is a key partner in Salford, providing better quality services to people with dementia.
	Last, but definitely not least, I should mention Salford Carers Centre, which plays a key role in identifying carers and helping them with information, advice and support. I believe that our practice in identifying carers, both in primary care and acute settings, is making a real and vital difference to helping our carers to care. I have invited the Minister, just as I invited his predecessor, to come to Salford to see what we do. The key other part of that now is Crossroads Care, which provides vital respite care.
	I will finish on the issue about the funding of care, as many hon. Members have done. The right hon. Member for Sutton and Cheam referred to the moving speech made by a carer at the meeting earlier in the week to launch a pamphlet he wrote. In her contribution, that carer described the difficulty of managing catastrophic care costs for a person with dementia. She said:
	“A £35,000 cap, as proposed by Dilnot (or even £50,000 or £60,000) could give me back my life. Our liabilities would be over. I could concentrate on my frail mum instead of the practical and emotional burden of single-handedly selling our family home. My mother has an incurable disease that has robbed us both of our lives; must it rob us of our assets too?”
	I could not put it better than that, so I will not try to do so. As other hon. Members have said, we must consider setting the cap, up and down the country, at a lower level than £75,000, which will help people such as this carer. I have outlined a number of ways to support the carers of people with dementia, and I hope we give them the priority they deserve.

Sarah Newton: I listened with great pleasure to my hon. Friend—I hope I can call her that—the hon. Member for Worsley and Eccles South (Barbara Keeley); I have the privilege of serving as her deputy on the all-party group on social care. I wish to echo the point she has just made, which was also so well made by my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who played such an important role in securing today’s debate.
	This is a very important occasion for us to show the collective will of hon. Members—there are so many here today—to hold the Government’s feet, and indeed the Opposition’s feet, to the fire. We need urgently to come to an all-party agreement on how to fund properly
	the future of care and social care in our community. I also wish to thank the right hon. Member for Salford and Eccles (Hazel Blears) for her contribution. I am sure that she will indulge me as I thank the chair of the all-party group on dementia, Baroness Greengross, who has dedicated her whole life, both in the other place and outside Parliament, to raising issues affecting older people, their families and carers so well. I thank the right hon. Member for Salford and Eccles for her part in securing this debate, which gives us such an important opportunity to de-stigmatise dementia and other mental illness.
	I remember only too well that when I was a child growing up people would not talk about cancer; it was whispered about or called “the C word”. Thankfully, we can now openly talk about cancer, which is to the great benefit of sufferers, their families, their loved ones and their carers. We must quickly move to the same position for people suffering from dementia, Alzheimer’s and a range of other mental health conditions.

Neil Parish: I agree very much with my hon. Friend that cross-party support on how to provide long-term care for people with dementia is essential, because our population is ageing. Better medical care means that people are living longer, but of course it also means that we will have more people suffering from dementia. It is right that we accept that situation as being part of society and as something we must deal with, but we must have a way of providing the funding so that we do not take away everybody’s assets to pay for treating dementia.

Sarah Newton: My hon. Friend makes his point well. I know that other hon. Members have very worthwhile points to make, so I do not wish to take up too much of the limited time available. However, I wish to make just a few points about how we in Cornwall are rising to the Prime Minister’s dementia challenge. It is right for us to set strategies nationally and to agree nationally on the overall frameworks to tackle one of the greatest challenges of our century. However, it is also important to look for the solutions locally. We should set the strategies nationally but enable everybody in communities around the country to come together to find their solutions. As the right hon. Member for Sutton and Cheam (Paul Burstow) rightly said in his opening remarks, we will all have to rise to the challenge. Every single part of society and every part of the public sector has its role to play. Indeed, as my hon. Friend the Member for Chatham and Aylesford said, the private sector, including supermarkets and other organisations in the public domain, has an important role.
	What have we done in Cornwall of which I am so proud and which I want to share with right hon. and hon. Members? Let us start with the NHS, because when people seek a diagnosis that is where they start off on their journey with dementia. We have set up the Kernow clinical commissioning group, which is very successful and has got off to a flying start. It has attracted a large sum of money from the dementia challenge—well over £500,000. What is it doing with that money? It is working very effectively in partnership with other parts of the public sector, voluntary organisations and other parts of the NHS to ensure that there is an integrated, joined-up approach in Cornwall.
	The CCG has targeted an issue mentioned by many Members, which is the need to ensure that everybody working in health and social care is properly trained, from carers through to doctors and nurses in the acute sector, to ensure that they are aware of dementia and how to talk to and relate to the people with this condition with whom they come into contact, as well as their families, friends and informal carers. The group is also using the money to ensure, among other things, that from the moment of diagnosis of dementia through to the end of life, sadly, there is a named individual available for that person and their family and carers. Obviously, it is early days as it just got the funding in November, but its ambitions are very important and will make a real difference to the quality of life of families in Cornwall.
	Another issue that has been mentioned today is the lack of care from some nurses in parts of the acute sector. I want to share with hon. Friends a great initiative in the Royal Cornwall hospital, which is our only acute hospital in Cornwall. The friends of the Royal Cornwall hospital, who have worked so well with nurses, doctors and managers over a long period, are addressing some of the issues raised today. They have a very good system of mealtime companions, who are specially trained volunteers who work alongside care assistants and nursing staff. When the staff are too busy, they provide the extra time, care, compassion and consideration that needs to be given to a range of patients, including those with dementia, to ensure that they have a drink and something to eat. The hospital is also open to family members and others at mealtimes. I recommend that hon. Friends take that issue up with their hospital trusts and use the example of Royal Cornwall, which has clearly found a way around the problem.
	The voluntary sector and society as a whole will have a hugely important part to play. Like many other hon. Members who have spoken, I am involved with the memory café in my constituency, in Falmouth. There are 24 other memory cafés in Cornwall and they are really important. People with dementia and other memory loss conditions, their families and their carers can come along to a safe, supportive environment, have some fun and do some interesting activities, talk to each other and get information. That is very important.
	In Cornwall, we are fundraising for Admiral nurses. Those Members who have Admiral nurses in their constituencies will know the very important work they do to support families in much the same way as Macmillan nurses support cancer patients and their families. Admiral nurses provide an invaluable service for people with dementia and I shall be working hard alongside those who are fundraising so that we soon, I hope, have Admiral nurses in Cornwall.
	I could talk about a lot of things, but for the sake of brevity let me simply say that many of the activities I have mentioned must be co-ordinated and planned. I want to reassure my Opposition colleagues that that is possible. Our health and wellbeing board in Cornwall has got off to a really good start. It works very closely with public health providers and all the different parts of the community, from housing to environmental health, to pull together a strategy for dementia and turn the good ideas and aspirations into action. I see the reforms to the NHS giving a great deal of power to doctors, other health professionals and people across the public sector to come together to work in partnership to
	deliver local solutions that work for communities. Salford is quite different from Cornwall and we all need to work together to find what works in our communities.
	A great deal of good work has been going on in Cornwall and will continue in years to come, but I am not complacent. We are a part of the country with a fast- ageing population and have yet to find ways to diagnose dementia accurately. We have some of the lowest levels of detection of dementia. I will work hard with colleagues in Cornwall in all sectors to drive that up.

Hazel Blears: Like the hon. Lady, I am keen to foster the sense of consensus and cross-party working on this essential issue, but the elephant in the room in this debate is the severe cuts that have had to be made to local authority social care over the past three years—nearly £1 million in Salford. I wonder how in her community in Cornwall, which will be facing similar issues, she is dealing with the impact of substantial cuts in day-to-day care.

Sarah Newton: I thank the right hon. Lady for that question, because it gives me a good opportunity to praise Cornwall council. Undoubtedly all local authorities are facing tough decisions as a result of having to make cuts. There have been no politics in this debate so I will not go on to say why we are faced with the mess and why we have to make those difficult decisions, which I am sure we would rather not have to make. Cornwall council has not cut at all its expenditure on adult social care.
	It gives me great pride to be able to stand up here and publicly thank Cornwall council for that. It is making sure that every penny that it receives from the Government—every single penny of the extra money to integrate NHS services with Cornwall council’s adult social care service—and the entitlement money and the money for carers’ respite is being spent. The council is not cutting front-line services for the most vulnerable people. The current settlement coming from the Government is increasing the amount of money into Cornwall for further improving and integrating the quality of care between adult social care and the NHS.
	Those of us who have been around this subject and who have been campaigning on it for years, which includes many of the Members in the Chamber, know that the future lies in joined-up, integrated services. It is not about throwing ever more millions of pounds at the problems. It is about being smarter and wiser and linking all those services around the patient, the carers and the families. That is what is going on in Cornwall.
	To summarise, I am in no doubt about the challenges that we face and I am not at all complacent. We need to build on the very good momentum and leadership shown by the Prime Minister on the issue to ensure that every family and everyone suffering from the condition gets the best possible care from us.

Alison Seabeck: Most Members in the Chamber will have received e-mails and letters and read in the media that MPs and people at Westminster have no idea what is going on in the real
	world. I hope people have been listening to and watching this debate and have heard the highly emotional, very personal, incredibly thoughtful speeches that we have had in the debate today, which give the lie to those cynical comments from those outside this place. I thank the Backbench Business Committee for allowing time for the debate and the right hon. Member for Sutton and Cheam (Paul Burstow) for opening it. His expertise and interest in care in relation to dementia are well known and noted, and I thank him for taking the opportunity, along with many others, to highlight one of the more important health issues facing the country.
	Unlike almost every other Member who has contributed to the debate, I have not had anyone in my close family suffer from dementia—I know people who have, but they were not immediate family members—so my speech might sound a little more clinical than others we have heard. We probably all know someone who has been touched by dementia. As we live longer, virtually every family will be affected and, as with cancer, we will have to learn to cope with an illness that a century ago people would not have lived long enough to experience. Indeed, only 30 or 40 years ago—20 years into my life—we would not have experienced family members having that awful degenerative disease.

Madeleine Moon: Does my hon. Friend agree that we must be careful not to make it sound as if dementia happens only to the elderly? Vascular dementia and prefrontal dementia affect young people. Certainly, prefrontal dementias tend to onset when people are in their 40s and 50s. We must not let the population of this country run away with the idea that dementia happens only to old people and that it is a consequence of old age, because that is not necessarily so.

Alison Seabeck: My hon. Friend speaks with enormous knowledge and is absolutely right. My godmother died at the age of 56 from Alzheimer’s, as it was described then, although I suspect that it was something much more complex.
	Our ageing population poses challenges, including how we discuss in a much more open and constructive way what has, in effect, been a no-go area. Cancer is a case in point. It is mentioned in hushed tones, in corners of rooms. The hon. Member for Truro and Falmouth (Sarah Newton) touched on that in her speech. Victims were often not told they had the disease. Dementia and Alzheimer’s have been treated in much the same way. As with cancer, I think that we are all learning not to be afraid of speaking about the disease. By doing so, we can better support those affected, their families and carers.
	We know that the number of sufferers is going to rise. The hon. Member for Plymouth, Sutton and Devonport (Oliver Colvile)—we duplicated on this a bit—pointed out that the number is rising significantly across the UK. Indeed, it will probably rise to 1.7 million people by 2050. In Plymouth, probably around 3,000 people have dementia—I say probably because many people with dementia will not have gone to their GP and their families might not be aware of their condition. That brings us back to a point made by my hon. Friend the Member for Bridgend (Mrs Moon), because there are potentially so many people out there who are yet to be diagnosed. That is why such debates are so important in
	raising awareness. We cannot simply carry on sweeping the issue under the carpet. It is a little like hiding bills behind a clock on the mantelpiece: they do not actually go away; they just mount up. The same applies to dementia; caring issues mount up, and costs certainly will.
	Dementia will cost the UK about £23 billion in 2013, yet dementia research is desperately underfunded, as we have heard. The Government invest about eight times less in dementia research than they do in cancer research. These are financially difficult times, but we need to ask whether we have that balance right. I welcome moves from the top of the Government to look at the priority dementia receives.
	Dementia is a particular concern in the south-west. Figures show that 40,000 people across the region have been diagnosed, and Devon has one of the highest levels in the country, in part because of our demography—people want to retire there, so there is a significant number of older people. However, as my hon. Friend the Member for Bridgend has put me right, it is not just an older person’s disease.
	I know from my constituency surgeries, as I am sure that others do, just how scary a diagnosis can be for patients and their families. We need to handle the diagnosis point with enormous sensitivity. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) made that point extremely powerfully and clearly. Every family copes in different ways, but they all ultimately need support. Some may pretend that they do not—that they can get on, manage and cope—but that is not the case.
	Carers tell me that they get stressed and worried when they are out with their loved ones. They are acutely aware that others do not understand the behaviour of the person they are with who is suffering from dementia. Shopping can be a simply dreadful experience. One carer said to me, “It would be so good to be able to go out shopping and not worry.” The hon. Member for Chatham and Aylesford (Tracey Crouch) made a good point about that. I am delighted to hear that companies such as Asda are training their staff better to recognise and support customers who are having difficulties. I hope that other companies out there have heard that and will look at the excellent work that those companies appear to be doing.
	Nor can we underestimate the pressure on carers’ mental health. They often struggle on in silence. We all know the type of person: they appear on the outside to be incredibly resilient, but in fact they are not. They need their needs to be fully understood, not only by the health service but by the people around them—those who work with them and live with them.
	In Plymouth we are working towards becoming not only a dementia-friendly community but a dementia-friendly city. We have some superb people leading the campaign and taking the steps to move it forward, including Ian Sherriff and Dr Helen McFarlane from Plymouth university. We have councillors and officers on Plymouth city council, as well as a welter of voluntary organisations. We also have an accredited memory service. The diagnostic rate for the identification of dementia has seen a significant improvement following the work by Dr Cartmell to map a dementia pathway, which has provided GPs with a useful educational tool to support referral, diagnosis and treatment.
	As we have heard from virtually every speaker, the early diagnosis of dementia is very important, as is the way in which society reacts to and supports those with the disease. People are helped to be empowered at a much earlier stage when they are better able to take important decisions about their care pathways. They are also enabled to share those decisions with the people closest to them, who may well be caring for them. Those affected should be able to take their own decisions for as long as that is feasible and possible. It is hugely important that they are able to take an informed view about their future life and lifestyle while living with dementia, guiding clinicians in the pattern of care wanted. Early diagnosis takes a certain tension out of the system, and we cannot overstate how important that is.
	As I mentioned, in Plymouth we have lots of organisations working towards our becoming a dementia-friendly city. The hon. Member for Plymouth, Sutton and Devonport talked about the naval base, HMS Drake, where people have signed up to play their part in the Plymouth Dementia Action Alliance. Human resources policies have been amended to support service families, who may also be caring for somebody with dementia. Someone on the front line on a tour of duty in Afghanistan already has an awful lot to worry about apart from worrying about a relative, or somebody they are very close to, who has dementia. It is enormously important for them to be confident that that person is in good and caring hands while they are a long way away and out of contact.
	The Dartmoor rescue team have also lent their skills. One might ask why, but I am afraid we have all heard these stories and all know people who have said, “A member of my family has left home and wandered off.” We have a young councillor on Plymouth city council whose grandfather has a habit of doing that and she often tweets asking whether anybody has seen him. The Dartmoor rescue team is bringing its expertise to bear not only by helping to track and find people, but by taking people for walks in areas they may be familiar with on Dartmoor and elsewhere.
	As we have heard, the private sector is also buying in and schools such as Stoke Damerel have taken an interest, because children have grandparents who may be suffering. Helping them understand what is happening to their gran or grandpa offers reassurance.
	I want to see the work that is being done in Plymouth to prepare us to be a dementia-friendly city come to fruition. I put on record my thanks to all those involved in the alliance who are pressing forward with that work. Importantly, I want every city in the UK to follow the lead of, and move in the same direction as, some of the country’s early pioneers.
	I recently attended the opening of Waylands in Ernesettle in my constituency. It is a residential centre for people with varying stages of dementia. It is a well-thought-through development and I would hope to see more such developments being built to such a high standard. Everything has been thought through, including memory boxes and the colour of the walls. It is a superb facility. However, there is an issue—this has been touched on by other Members—namely the recruitment of staff with the right qualifications and attitude towards nursing and supporting patients with dementia. The centre tells me that it has been quite easy to recruit care assistants with good qualifications and the right attitude, but much
	more difficult to get properly trained dementia nurses. What is the Minister’s Department doing, alongside the Departments for Education and for Business, Innovation and Skills, to ensure that we have enough people with the right skills to meet that undoubted need? We also need reassurance that those people are properly trained. We do not want a recurrence of what happened in Stafford.
	Patients with dementia cannot whistleblow, which is a real issue. If someone does not have a family around them to identify the problems they face, how will their voice be heard? As my right hon. Friend the Member for Cynon Valley (Ann Clwyd) has said, too many people are alone in hospital who do not have people to take action to feed them. I cannot say how strongly I feel about the importance of good, compassionate nursing care to look after people with every need—and I mean every need—and ensure that they eat and live as long a life as possible, given their conditions.
	We also need to take into account the fact that dementia sufferers have a range of other physical ailments. We need to learn and do better on the ways in which they are nursed and how clinical teams handle them. These people are very afraid, in strange circumstances, often alone and faced with strange equipment and various other things. I genuinely think that an awful lot more could be done to make their progress through the health-care system altogether more sensitive to their individual needs.
	I look forward to hearing the responses of both Front-Bench representatives to this debate. I want a firm commitment to a long-term dementia strategy but, more importantly, we have to have a national solution for care and it has to be affordable. As other Members have said, the figures in the press this week seem to be excessively high, but I will wait to hear what the Minister has to say about that.

Guy Opperman: These are, as Charles Dickens put it, the best of times and the worst of times. It is a time of plenty; it is a time of difficulty. It is a time of great medical advancements, and yet a time of a greater number of dementia sufferers. It is a time of conflict on the Floor, and yet a time of shared priorities and shared understandings of the difficulties that we all face. Any person who wishes to understand the House of Commons should have been present today when, to be frank, we have seen the best of the House. The hon. Members for Oldham East and Saddleworth (Debbie Abrahams) and for Bridgend (Mrs Moon) gave the finest speeches that I have heard for some time, and the Under-Secretary of State for Health, my hon. Friend the Member for Broxtowe (Anna Soubry) made the best intervention by a Minister that I have heard for a long time and for which we will all be grateful to her. These things are remembered in this place.
	Members of my family have suffered from dementia and anybody who has suffered from a brain tumour, as I have, will know of the insidious creeping of memory loss, the loss of brain function through neurodegenerative disease and the huge difficulties that those things entail. I am very fortunate that I had the operation, recovered
	and am, I like to think, better than I was previously. I believe that my experience gives me a unique insight into the early onset of the brain disorder that constitutes dementia. It is a terrible thing. It is a harrowing, upsetting and difficult thing to have to deal with.
	I will speak about the reality in my constituency, but I am having to abbreviate my speech massively. Tynedale, which I represent, is a dementia-friendly community with well over 1,000 sufferers. It has outstanding GPs, care homes and hospices, and an NHS community that is doing a fantastic job. I pay tribute to Age Concern, Headway and the Alzheimer’s Society, which do a great job. I also pay tribute to homes such as Wellburn House in Ovingham, Helen McCardle Care’s Acomb Court, the Abbeyfield homes in Corbridge and Ponteland, and Tynedale Grange in Haltwhistle, all of which provide exemplary elderly care and do all that they can to assist those who are suffering from the onset of dementia.
	Ever-increasing work is being done by the national health service. As I said at the outset, it is good that there is greater understanding of this problem and that attempts are being made—of course, we all want more to happen—to provide the analysis and research that are so desperately needed for a true focus on neurodegenerative disease. Surely the most difficult part for the Government is to have joined-up services. We can talk about individual good examples from communities up and down the country, but until there are joined-up medical services, provided on a multitude of bases to individual patients, we will always struggle. That is the most important thing for the Government to work on, even if they do nothing more.
	Like others, I welcome this debate. It does great credit to the Backbench Business Committee and to the right hon. Member for Sutton and Cheam (Paul Burstow), my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and others who have promoted this issue.
	The Prime Minister has had the guts to stand up and make sure that people understand that dementia is no different from cancer or heart disease—it is a fundamental disease and a killer. However, because it is unseen and intangible, it is difficult to comprehend the problems that it entails. I welcome the increased funding.
	I want to make three points in my abbreviated address. The first is about the need for joined-up Government. There must be ways in which Government can advise, cajole, improve and give assistance to the various providers at the various stages in the system, such that all their individual efforts become a collective effort.
	Secondly, I welcome the fact that intellectual stimulation is still seen as the best method of preventing degeneration in cases of dementia. In that respect, we must be careful not to become too accountant-focused in the provision of health care services. I made my name as a pro bono lawyer fighting the decision to close services at Savernake hospital. I regret to say that the previous Government were involved in that, but other Governments have done such things in the past. We have to focus on the parts of the health care system that are providing the intellectual stimulation that is the preventive in these matters.
	Finally, I represent a community that contains one school with a catchment area roughly the size of the area inside the M25. West Northumberland is the least populated part of the country and rural health care is monumentally more difficult than urban health care.
	I do not dispute that these matters are difficult everywhere, but if someone is two hours’ travel from a hospital or an hour from their local GP and has problems on an ongoing basis, it is immensely difficult to provide health care. The Government must bring their attention to bear on how they can assist NHS organisations in the provision of rural health care in the future, and on how to tackle this insidious and terrible disease.

Liz Kendall: It is a real privilege to have listened to so many excellent and moving speeches from both sides of the House. This is by far the best debate I have sat through since becoming a Member of Parliament and I feel very lucky to be part of it. I thank the Backbench Business Committee, and warmly congratulate the right hon. Member for Sutton and Cheam (Paul Burstow), my right hon. Friend the Member for Salford and Eccles (Hazel Blears), and the hon. Member for Chatham and Aylesford (Tracey Crouch) on securing this extremely important debate.
	As we have heard many times today, dementia is a cruel and distressing disease that affects an increasing number of people in this country. Like many hon. Members who have spoken, I have seen the impact that dementia has had on my constituents and in my own family. Women in their 60s and 70s are seeing their once proud, sharp and vivacious husbands not only struggle to get up in the morning or go to the toilet, but to finish sentences and remember key points of their married lives together, and their hopes of having a great retirement with the person they love are fading away. Sons and daughters are trying to help their mums and dads walk, talk and feed themselves—just as they used to do for them—and coping with the terrible shock when their own parent does not recognise them or seem to know who they are.
	Dementia is distressing not only because of the physical impact it can have on the person with the condition and the practical struggle that many families face in caring for their relatives, but because it affects something so essential to our humanity—our relationships with our families and the people we love and care for most. Relationships are based on memory and shared experiences. If memory fades and those experiences and relationships are lost, it feels as if the disease is taking away the essence of the person we love and therefore something fundamental about who we are too.
	People are frightened of dementia because they fear it will destroy their minds and relationships as well as their bodies, and because they think that nothing can be done. That, however, is not the case. Although there is currently no cure for dementia, as many hon. Members have said, with the right care and support, people with dementia can enjoy a good quality of life, even in advanced stages of the condition.
	Hon. Members have spoken passionately about services in their own constituencies and places they have seen. Last year I visited a day care centre, Dove House in Barnet, provided by the fabulous Alzheimer’s Society. The people there told me how going to that day centre and having stimulating, non-medicating help and support such as gardening, cooking, singing or music, had brought their loved one back to life in a way they did not think was possible, and also that they had got a desperately needed break and therefore their relationship had improved.
	There is superb residential care for people with advanced dementia at Fountain Court in Wolverhampton, which I visited last year. It is run by an inspirational manager, Michaela Wilson, who demonstrates the kind of creative thinking mentioned by my hon. Friends the Members for Liverpool, Walton (Steve Rotheram) and for Bridgend (Mrs Moon), and many others. I will give two brief examples of that.
	First, there was one resident who never took a cup of tea. Michaela Wilson was worried about that because people need hydration, but she saw that he kept tapping his pocket and realised, “Ah. He is used to having change in his pocket and thinks he is supposed to pay for this.” She gave him change every morning; he put it in his pocket, it always fell out, but he took a cup of tea.
	There is a second example of such creative thinking. The home is brilliantly designed—lights go on when people get out of bed, and doors open. There was a yellow toilet seat because people with dementia recognise colour, but one guy kept getting out of the other side of the bed and going to the toilet in the bin. The staff were getting a bit annoyed, so Michaela Wilson said, “At least he recognises he’s supposed to go to the toilet somewhere,” so they put a second bin there. The man slept better and was more relaxed. It was a fantastic service.
	The quality of dementia care is changing, but not quickly enough and not in enough parts of the country. Many hon. Members have said that we need to do for dementia over the next 10 years what we have done for cancer over the past 20 years. Above all, we need to give people hope that something can be done. That is essential in ensuring that everyone gets an early diagnosis, because people do not want to come forward if they believe that nothing can be done if they are diagnosed.
	We must do even more to raise awareness of dementia and to tackle the stigma many people still feel, so that they are not embarrassed if their husband, wife, mum or dad butters the plate and not the toast in a café, or if they cannot order from the menu. We must transform information for families and say what dementia is, how it can affect them and what help and support is available. There are many different bits of information in different places, but for such a distressing condition, we need to bring it together.
	NHS social care and voluntary services must work far better together—that point was made by many hon. Members, including the hon. Member for Hexham (Guy Opperman)—so that families do not have to battle different parts of the system when they are already distressed enough. Care and support must be personalised to each individual and their family. Dementia affects people’s memory and the way to reach out to them is by finding a hook into that memory, so care and support must be highly personalised.
	That has radical implications for the education, skills and training not just of nurses and care assistants, but of general practitioners and managers, who must hold their staff to account for the care they provide. That is particularly relevant in communication skills, as my hon. Friend the Member for Bridgend has said, and, as many hon. Members have said, we need further progress in dementia research.
	The Labour Government began the journey towards delivering better dementia care—I am grateful that the right hon. Member for Sutton and Cheam recognised
	that. In 2009, we launched the first ever national dementia strategy, “Living well with dementia”, which began the process of establishing memory clinics, providing better training for GPs, and improving the quality of dementia care for people in hospitals.
	In early 2010, we appointed the first national clinical director for dementia and commissioned a quality standard for dementia from the National Institute for Health and Clinical Excellence. The current Government’s dementia challenge builds on many of the improvements Labour introduced. I welcome the increase in funding for dementia research and the aim of creating more dementia-friendly communities. If the Alzheimer’s Society in Leicester, Leicestershire and Rutland is anything to go by, I am sure the Alzheimer’s Society nationally will do a superb job in recruiting and training volunteers as dementia friends.
	However, we need to assess those initiatives against the wider and—I would argue—far bigger impact of the Government’s policies on the NHS and local council social care. Let us look at district nursing, which is just one essential aspect of better dementia care. Those vital nurses work alongside GPs, care assistants and other staff to help people who usually have dementia and another condition—co-morbidity and multi-morbidity are the big challenges we face. District nurses help people to stay healthy and well, living in their own homes, but 1,400—one in five of the total—have been cut since the coalition came to power. That is not good for patients, but it is not good for taxpayers either, because people with dementia end up in more expensive hospital or residential care when they cannot get the support they need to stay at home, which is what they want to do.
	Delays in patients being discharged from hospital specifically because of a lack of NHS services in the community—this is not about social care, but about NHS in the community—such as district nurses have increased by 38% since August 2010. The delays cost the NHS £6 million every month.
	If the problems and difficulties in the NHS are bad, those in social care are far worse. More than £1.3 billion has been cut from local council budgets for older people’s social care since the Government came to power. As my right hon. Friend the Member for Salford and Eccles (Hazel Blears) said, council budgets are being cut by a third. Adult social care makes up about 40% of that budget and is councils’ biggest discretionary spend. Any money that is going across from the NHS is not ring-fenced, so inevitably those services are suffering. Councils are doing their best to save money by changing the way care is provided and by working more closely with the NHS. Faced with the scale of cuts to council budgets, however, many have little choice but to restrict the number of people who qualify for help, reduce day care services and increase charges for vital support, such as home help and residential and respite care, if they are to balance the books.
	That is having a real impact on people with dementia. We are seeing an increasing number of 15-minute home visits. They are simply not long enough to get a very frail and distressed elderly person with dementia up, washed, dressed and fed, and end up costing the taxpayer more. The Alzheimer’s Society says that one in five people
	with dementia are admitted to long-term care institutions earlier than would have been the case had they received the right support at home.
	There is a dementia challenge, but we cannot tackle the crisis in dementia unless we tackle the crisis in care. That means addressing the current and growing crisis in social care and putting in place a better, fairer system for the future. This is not an easy thing to do, as Labour discovered when we were in government. We have welcomed Andrew Dilnot’s recommendations on long-term care funding as a step towards a better, fairer system. We initiated cross-party talks on this vital issue, which unfortunately broke down when the Government unilaterally issued their own progress report on funding care and support, but I want to state clearly for the record that if the Government were serious about those talks, we would be back in like a shot. We now see media reports that the Government intend to implement the Dilnot principles, but not until after the next election, and put a cap on care costs at £70,000 or above, rather than the £35,000 Dilnot recommends. Dilnot says that
	“moving outside the range of £25,000 to £50,000 could mean that the overall reforms would fail to satisfy our criteria on fairness and sustainability.”
	Capping care costs above £50,000 would mean
	“people with lower incomes and lower wealth would not receive adequate protection.”
	A £75,000 cap would not even help many families on middle incomes. The long-term care insurer, Partnership UK, says that a person paying the average cost for a single room in a nursing home in the south-east would not hit the cap for five years because that care is so expensive. The average length of stay in Bupa care homes is about two years. In other words, the person would die before they reached the cap. There is a concern that a £75,000 cap would not encourage people to take out insurance because the premiums would not be affordable. If these reports are true, will the Minister stop, think again and get around the table for cross-party talks, so that together we can put in place a decent, fair and sustainable plan for the future?
	In conclusion, we need fundamental reforms to transform dementia care. We need one care system, not separate systems for people’s physical, mental and social care needs. We need care and support that is radically reshaped around the needs of individuals that involves their families and the wider community, and is provided by NHS and social care staff with the right skills, training and understanding. Like my right hon. Friend the Member for Salford and Eccles, my parents taught me the values of justice and fairness. In the century of the ageing society, we will deliver justice and fairness to people with dementia only if these reforms are made. I hope that that is something Members on both sides of the House will work together to achieve.

Norman Lamb: I would like to thank the Backbench Business Committee and every right hon. and hon. Member who has spoken, and pay tribute to the former Minister, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), for his dedicated work on the subject and to the work of the all-party group on dementia, which works tirelessly on a subject that, in the past, has been too much ignored but which, at long last, is starting to get the attention it deserves.
	I cannot begin to do justice to the many extraordinary contributions made in the debate, so I commit to write to all hon. Members who have taken part to answer each of the specific challenges put to me, if I cannot deal with them now. A forum such as this—less combative than many of the debates on the Floor of the House—is the perfect place to talk about dementia. I have listened with humility to the contributions of many hon. Members and I completely associate myself with the comments of the shadow Minister: the contribution from the hon. Member for Bridgend (Mrs Moon) was remarkable. She spoke with authentic authority, having experienced all these problems—the isolation, the impact on the family and so on.
	I have learned much in this debate, as a Minister learning my trade, and will take onboard much of what has been said. I should also mention the right hon. Members for Cynon Valley (Ann Clwyd) and for Salford and Eccles (Hazel Blears) and the hon. Member for Liverpool, Walton (Steve Rotheram), who, along with others, paid tribute to the fantastic work of the Alzheimer’s Society, which I have seen in my own constituency. It is a brilliant organisation doing invaluable work. I totally agree also with the shadow Minister about the analogy with cancer. Getting to grips with Alzheimer’s has to be seen as the challenge of the 21st century. I am sorry I missed the contribution from the hon. Member for Oldham East and Saddleworth (Debbie Abrahams), but I have heard all about it and thank her as well.
	There is no party political divide on dementia. There can be discussions about the funding of social care and so forth, but there is a consensus about what needs to be done. The work was started by the last Labour Government, who took a lead internationally in setting out a proper strategy for dementia, and this Government have taken on that strategy and developed it. I pay tribute to the Prime Minister for his personal commitment, as others have done. Whatever our political affiliations, beliefs or background, we all know that dementia is one of the most important health and social care issues facing society. It is also one of the most pressing. As mentioned, we know that dementia costs society about £19 billion a year. In 30 years, as the number of people with dementia doubles, even that vast sum will look like chicken feed.
	As with all health and social care issues, however, we do people a disservice to reduce dementia to money and budgets. It is about much more than that; it is about people and how we treat them, about the individual with dementia, their families and their friends, all of whom have to live with the effects of what can be the most terrible of conditions, but a condition that many people can and do live well with. That is an important message to get out. It does not necessarily mean the end of the world. People can live well with it.
	Dementia affects all of society. It is a universal concern. Study after study shows that it is the condition that people fear the most—more than cancer or anything else—so we need to be better prepared. The Department of Health is doing all it can to stitch dementia awareness into every part of the community—not just GP surgeries, hospitals and other health-focused places, but banks, supermarkets, bus stations, post offices and all the different forms of local public services, and the private sector too. The whole of society has to play its part in changing attitudes and making society dementia friendly.
	All those places can become more dementia aware and dementia friendly, and if they do, people with dementia will benefit and live better.
	On 26 March last year, the Prime Minister gave a speech about the Government’s challenge on dementia. He said that we would do more to translate the national dementia strategy into greater action on the ground in three key areas: first, improving health and care; secondly, making communities more dementia friendly, so that people with dementia are better understood and catered for; and, thirdly, doing more research into dementia. When he launched the challenge, the Prime Minister said we would set out plans to make life better for people with dementia and their carers. Indeed, the hon. Member for Worsley and Eccles South (Barbara Keeley) spoke movingly about carers and mentioned that she had invited me. I think I am going, and I very much look forward to hearing about the good work done in Salford.
	That announcement was almost 10 months ago. I am pleased to say that since then there have been significant developments in each of the three strands in the Prime Minister’s challenge. Each has been run by a champion group that includes experts in their fields—Sir Ian Carruthers from the NHS, Sarah Pickup of the Association of Directors of Adult Social Services from social care, Sir Mark Walport and Dame Sally Davies from research, and Jeremy Hughes from the Alzheimer’s Society, as well as Angela Rippon. Those groups have looked at the current situation in their fields and identified priorities for improvement. They include changing how society views people with dementia, improving diagnosis rates and getting researchers to work together in pursuit of better treatments. Several hon. Members have mentioned the stigma of dementia. We face similar challenges in mental health generally. “Time to change” is a fantastic campaign, but the challenge is just as great with dementia. There is still an awful lot of work to do.
	I would like to read a quick summary of what we have undertaken since last March. We have launched a new dementia friends scheme to make 1 million people more aware of what dementia is, helping to break down barriers between people with the condition and their local communities. The hon. Member for Liverpool, Walton and many others talked about the importance of raising public awareness; the dementia friends scheme can be an effective way of doing so. Indeed, I urge all hon. Members present to sign up—they can do it now by registering online—and become dementia friends. He made the point that public awareness was, in his words, scandalously low. I share that view.
	We have set aside £54 million for the NHS to support dementia diagnosis in hospitals and now to ensure clinical leadership in hospitals. We have set aside a further £50 million to make health and care environments such as hospital wards and care homes more dementia friendly. The Government’s first mandate for the NHS prioritises dementia. We have launched a national advertising campaign to raise awareness, reduce the stigma attached to dementia and encourage people to contact their GP if they experience symptoms of dementia and have that difficult early conversation—the sooner it is had, the better for the person with dementia and their carer. We have developed a toolkit for clinicians to increase diagnosis rates—we have heard about the
	interesting work in Plymouth and how diagnosis rates have been significantly improved as a result of that clinical leadership.
	Through a consultation, we asked the public what action they wanted to see and incorporated those views into the work of the three challenge groups—the hon. Member for Bridgend was absolutely right that people must be involved, engaged and listened to in dementia research. We have also supported the launch of the call to action to create dementia-friendly hospitals. Some 65 hospitals have signed up so far, but I take the view that every hospital in the land should sign up. I urge them to get on with it, because it is so important. The hon. Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Cynon Valley gave powerful testimonies and told some deeply disturbing stories about what happens in some of our hospitals. That reinforces just how important this is and why the Secretary of State is right to be clear that the quality of care is just as important as the quality of treatment.
	The hon. Member for Bridgend talked about the crucial importance of communication between care staff, nursing staff and relatives. The hon. Member for Banbury (Sir Tony Baldry) talked about getting compassion back into the NHS. There is actually an enormous amount of compassion in the NHS, but there are sometimes situations where it falls below the acceptable standard. That is what we have to address.
	We have provided £36 million for a new National Institute for Health Research translational research collaboration on dementia, with research into better treatments, care and understanding of the condition. We have also provided £9.6 million to expand the UK Biobank.
	I am conscious that I am not going to have nearly enough time to deal with all the issues that have been raised today. A great deal of emphasis has been placed on the importance of early diagnosis. The right hon. Member for Salford and Eccles talked about the completely unacceptable regional variations. All clinical commissioning groups will have to set ambitious objectives to close the gaps, and they must be held to account for that. The National Commissioning Board will build up a national picture of the challenges in each local area. The hon. Member for Plymouth, Moor View (Alison Seabeck) talked about the encouraging progress that can be made in that regard. People want timely, good-quality information that helps them to make the right choices about their care. The hon. Member for Bridgend talked about the importance of the GP discussing with the family the approaches that they want.
	In conclusion, the coalition Government are doing as much as possible, but there is much more to be done. We will make an announcement soon on funding for elderly care. The Care and Support Bill must, in my view, include paving clauses on Dilnot. We have a real opportunity now to secure the reform that is so long overdue. We should also remember that the Dilnot recommendations included raising the threshold for means-tested support to £100,000, which would help an enormous number of families who are experiencing real difficulties.
	To address the challenges of dementia, we need a response not just from the NHS, not just from the Government and not just from businesses, but from
	society as a whole. There are promising signs. The Prime Minister’s dementia challenge is not only about geeing up the NHS and our local authorities, but about all the resources that our communities have to offer. I completely agree with my right hon. Friend the Member for Sutton and Cheam that we need to develop the strategy beyond 2015. Of course, we will need to assess and learn the lessons from the current strategy, but we must then apply it beyond that date. The same applies to research as well; I completely agree with him on that.
	There is a lot of hard work being done by the NHS, by social care professionals and by others across England—work that is increasing diagnosis rates, and reducing the prescription of antipsychotic drugs for people with dementia, to name but two. As a consequence, many more people are getting the treatment and care that they need and that their loved ones deserve. Long may that continue.
	I am on a learning curve as a new Minister, and I have found this debate immensely helpful. As I said earlier, I have learned a lot from it. I dedicate myself to doing everything I can, for as long as I have this job, to try to make a difference.

Paul Burstow: On behalf of my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) and the right hon. Member for Salford and Eccles (Hazel Blears), I would like to thank each and every one of the Members who have contributed to the debate. Some of the speeches were personal; they were all powerful and moving, and they speak to why this debate cuts across party divides. It is not about party dispute; it is about party consensus across the House. On behalf of my colleagues, I also want to thank the Backbench Business Committee for scheduling the debate.
	I want to highlight a number of areas. The first is early diagnosis. Many Members have said that it is absolutely critical and makes a big difference. However, a diagnosis that just hangs a label around a person’s neck does not make a difference. What makes a difference is understanding the person, the journey they have been on and the journey they are about to embark on when they receive that diagnosis.
	That brings me to the second area, which relates to care and treatment. In order to understand a person, we need to know them. If we know them, we can ensure that they have a sustained, adaptable and joined-up package of care and support that moves with them and their needs as their condition progresses, and that must apply not only to them but to their friends and family. We have heard some harrowing accounts today of how compassion has been absent from our national health service and our care services, but we have also heard stories of hope, where things are going better. They are the beacons that we need to look to, and we need to light more of them around the country.
	A third area is research, which is also about hope. We need to ensure that we invest in understanding so that we can defeat the disease and, in the meantime, treat people much better. If the debate delivers no other message to the Government today, I hope that it will deliver this one: this Government really need to lead
	and deliver when it comes to research and reform; they need to get on with it. It is long overdue, and it is time for the coalition to deliver it.
	Question put and agreed to.
	Resolved,
	That this House has considered the matter of dementia.

Business without Debate

WELSH GRAND COMMITTEE

Ordered,
	That—
	(1) the First Report of the Commission on Devolution in Wales, Empowerment and Responsibility: Financial Powers to Strengthen Wales, be referred to the Welsh Grand Committee for its consideration;
	(2) the Committee shall meet at Westminster on Wednesday 23 January at 9.30 am and 2.00 pm to consider the matter referred to it under paragraph (1) above; and
	(3) the Chair shall interrupt proceedings at the afternoon sitting not later than two hours after their commencement at that sitting.—(Karen Bradley.)

EDUCATIONAL SUPPORT (CHILDREN WITH CANCER)

Motion made, and Question proposed, That this House do now adjourn.—(Karen Bradley.)

Mark Tami: I begin by congratulating CLIC Sargent on its report, “No child with cancer left out”. It is an excellent report that addresses many of the challenges facing children with cancer and raises awareness of the impact that such a diagnosis can have on a child’s education. The report centres on those returning to primary education, but it is just as relevant—many of its points are just as relevant—to those attending secondary school, as well.
	Every year, around 2,000 young people aged 16 to 24 are diagnosed with cancer. For those aged up to 15, it is around 1,600. That equates to about 10 families a day being given the devastating news that their child has cancer. That will affect not just the child’s life, but the whole family’s life, including the siblings and everyone around the family. As parents, there is nothing that can prepare us for it. The parent’s world is turned upside down, and all the things that seemed important just the day before suddenly become totally and utterly irrelevant.
	The child embarks on a programme of treatment that, while necessary, is frightening for all concerned. In many cases, medical intervention will take years, with many ups and downs along the road. For leukaemia, under standard protocol, it will take three years of treatment for boys and two years for girls. For other cancers, it will be a combination of chemotherapy, radiotherapy and surgery. For some with more complex conditions or for those who relapse, it will mean a stem cell or bone marrow transplant.
	Speaking as a parent of a child who was diagnosed with cancer, I can honestly say that at the time, the last thing I thought about was the future or current educational needs of my son, Max. It never crossed my mind at all. I was totally focused on getting him through the medical battle against this dreadful disease.
	That issue has perhaps become part of the problem in that there is no co-ordinated approach to support the child after treatment in respect of education. We tackle and address the physical and medical side, but fail to consider the educational and social needs of the children affected. That is a problem not just for parents, but for schools, local authorities and, indeed, Government policy.
	For children who thankfully survive cancer, that is far from the end of the story. For most, it is the start of another journey—this time of trying and working to get back into school, and of re-building and re-establishing friendships with the peer group. It is important both to get the peer group to understand what the children have gone through and to support them in going forward.
	The CLIC Sargent report found that nine out of 10 children with a cancer diagnosis and subsequent treatment reported that their school life was affected. Two key issues need to be addressed: first, how the school and education authority respond to support the child on return to school and prior to that return; and, secondly—perhaps too often overlooked, but none the less vital—how to prepare the school, and class mates in particular, for the child’s return to school.
	On that second point, there appear to be no established procedures to advise and help schools and teachers. There is some good practice out there and some respondents detailed in the report say they had a very positive experience for their child—but, equally, the reverse can be the case. Some schools are ill prepared, or perhaps understandably reluctant to address what is a very difficult issue, particularly when very young children are involved.
	We can, after all, put ourselves in the position of the classmates of one of those children. One moment the child is at school playing games, and the next moment he or she is gone, for what must seem a very long time in the life of the other young children. They may send a card, but they will have no other real contact. When the child returns to school, he or she may look very different as a result of chemotherapy and steroids. Lack of hair, a minor issue in itself, may seem particularly strange to younger children. A central line visible through clothing may be difficult for them to comprehend, and probably quite frightening for them.
	The other children will obviously have questions to ask. Why has it happened? Could it happen to them? Will the child get better? Is it possible to catch it? I am sure that there will be a host of other questions. Such issues, however, need to be addressed before the child returns to school rather than afterwards, when concerns and, in some cases, bullying may arise. The CLIC Sargent report highlights what is, thankfully, a minority of cases in which classmates have bullied children out of jealousy because of their lower attendance at school, or because they have been on a supported holiday to Disneyland or Lapland through a charity such as the Make-A-Wish Foundation. Perhaps it has not really been explained to the classmates why the child has been allowed to be away from school for such a long period.
	Let me say at this point how important I think charities such as Make-A-Wish are in boosting a child’s confidence and well-being. I have done some work with the Ellen MacArthur Cancer Trust, and my son has certainly enjoyed his experience of it. The trust does excellent work in bringing young cancer sufferers together to meet the challenges that sailing can provide. It is really positive, and really helps them to build their confidence.
	Whatever form bullying may take, I think that it is mainly born of a lack of understanding of what a child with a cancer diagnosis has actually been through. In the time in which such children have been absent from school, many of their classmates will have moved on and made new friends. Trying to re-establish former friendships may not be easy, particularly if the child who has been absent is unable to participate in the same activities and games as before. One of the most telling quotations in the CLIC Sargent report comes from a parent who recognised that
	“returning to school isn’t just about educational needs—it’s about emotional ones too.”
	I think that that is just as important as supporting the academic side of a child’s education.
	CLIC Sargent and a number of hospital schools can and do offer support for teachers through events such as teachers’ days, but they cannot be expected to provide
	across-the-board cover. We need more joined-up thinking on the part of local authorities and hospitals to ensure that a more comprehensive and co-ordinated approach is adopted to enable schools and teachers to tackle the issue. That applies not just to state schools but to private and free schools, and to secondary as well as primary schools. The Anthony Nolan “register and be a lifesaver” campaign is an excellent example of the way in which young people can be educated in how they can save lives by joining blood, organ and cell registers.
	The second issue that I want to raise is the actual educational support that is available to children, both before and after their return to school. The CLIC Sargent report found that over 70% of children had received some form of education during their treatment, either at a hospital school or through home tuition, or in most cases a combination of both. While local authorities have a statutory duty to provide suitable education to children with an illness, there are still issues in respect of children with cancer accessing provision. Hospital schools play an important role when a child is in hospital for a prolonged period, and I can certainly say from my experience that they help re-engage children in what we call normal life, outside of just coping with the treatment itself. When a child leaves hospital but is still unable to return to school, access to home tuition becomes vital.
	The report highlights that securing home tuition provision can be far from straightforward. My own experience with Flintshire county council was very positive. My son had an excellent teacher, Jane Watts, who helped him through a very difficult period both in respect of teaching and in being someone to talk to, and I thank her for all the help she gave us. Other parents have not been so lucky, however. Some have found that either the provision is not available or it seems to take an inordinate amount of time to set it up. While entitlement to home tuition in terms of the number of hours to be provided is not defined in law, the majority of local authorities provide a minimum of five hours a week, and that is what my son got. In the vast majority of cases, that level of provision is not enough, and it therefore needs to be increased.
	There needs to be flexibility so that provision can be varied, depending on the child’s needs at various times. If the child is undergoing treatment, five hours may be too much, while at other times the child may be able to cope with, and may want, a lot more time than that. It seems strange that in many cases if the child had been excluded from school for bad behaviour, rather than because they had a cancer diagnosis, they would get much greater provision.
	Flexibility is key, therefore, but we should also extend provision so it does not just stop when the child returns to school, because it is a vital component in helping children catch up when they return to school and in allowing for further periods of absence. My son had a number of post-transplant absences from school; graft-versus-host disease can lead to weeks, or even months, off school. We were able to pay for extra home tuition once the local authority provision had stopped, but that is not an option for many parents because of financial constraints. I am concerned that in our current difficult financial climate, rather than access to home tuition being extended, it might become even more limited.
	That must not be allowed to happen. I hope the Minister will address that point, and will agree that we must ensure that quality provision is maintained and enhanced.
	The next challenge is the return to school itself. In the CLIC Sargent report, 56% of parents said that their child found it difficult to readjust to school; many found that their child’s skill levels had regressed since treatment and that their child found core subjects, particularly maths and English, far more difficult. CLIC Sargent also found in an earlier 2011 report that 64% of 16 to 18-year-olds with cancer fell behind with their work and failed to attain the results they had expected, with 29% of all young people surveyed saying they had left education altogether.
	There is a broad consensus that children with cancer need extra support in school, but there is a lack of agreement on, and understanding of, what that level of support needs to be and the nature of it. Some children will need a minimal level of additional support, whereas others will need a far more formalised special educational needs assessment, which will in some cases go on for their entire school career. No matter how effectively children’s needs are assessed on their return to school, and particularly if they receive extra support, an ongoing level of assessment and support still needs to be provided, as circumstances can change. That goes back to the point I was making earlier: the path to normality is not steady; it is a bumpy road, and there will be plenty of ups and downs along the way.
	Therefore, flexibility in provision is key, but clearly that provision needs to be there in the first place. The children and families Bill, which will be before this House in the coming months, gives us the opportunity to build in such provision and guarantee children with cancer the support they need. My concern is that the Bill, in draft form, seems to focus predominantly on children with a high level of special educational needs. I understand why that is, but many children with cancer may not meet those criteria, and may receive little or no support as a result. The Government therefore need to ensure that their definition of special educational needs includes all children with a disability, in order to ensure that education providers’ duties under the Equality Act 2010 are integrated into the raised special educational needs code of practice. For children with mild or moderate special educational needs, there needs to be more clarity on how a new, single, school-based category of special educational needs will interact with the local offer and school-based support. We also need to know how parents can ensure that their child is provided with the level of support they need, and that that support continues throughout to meet their educational needs. Even if there are periods, right up until they go to university, when they drop out and then go back into education, that support should be maintained all the way through and they should not have to go through a laborious process to get it again.
	Children with cancer experience many challenges in life, none more so than fighting the disease itself. For those who win the battle, or continue to fight, the very least we must do is provide an environment in which they can reach their true potential in life. Education is the key to that future, and we should do everything we can to provide the additional support that those children need. We need greater co-operation between schools, local authorities, hospitals and Government policy to
	ensure that that aim is actually delivered. We need to be more co-ordinated; we need to be more joined up in our thinking. These young people need our support and we cannot let them down.

Elizabeth Truss: I thank the hon. Member for Alyn and Deeside (Mark Tami) for raising an important issue and for his very moving speech about his experience and that of his son, Max. It was particularly informative because it was based on the personal experience of parents and children going through that difficult and troubling situation. It has been very helpful in informing the Government’s policy and I hope that he will continue to engage with the Government, particularly given the forthcoming Bill, which covers some of the issues he raised in his speech. I praise the report by CLIC Sargent and the important work that that charity does to support children. The hon. Gentleman also mentioned the Ellen MacArthur Trust and its vital work.
	The Government believe that pupils with cancer deserve as good an education as any other pupil and poor health should never mean poor education. We need to provide good education to all, regardless of their personal circumstances or educational setting. The hon. Gentleman is right to highlight the issues for children with cancer as well as those suffering from other illnesses and problems. The problems are very real, but I hope to outline some of the steps the Government are taking to address them. I will also take on board some of his comments for our future work.
	We want schools to ensure that they exercise their professional role in supporting all students. They are best placed to know the circumstances of the individual children, what support is most suitable, what is available and how to work with other local bodies. We do not want to prescribe a set of processes for them to go through, because we think the focus should be on outcomes and how the children and families are affected.
	I completely agree with the hon. Gentleman that sharing information effectively and efficiently is essential. All relevant information should be shared with the parties involved. Obviously, there are issues about being in touch with data protection principles, but that should not discourage schools or others from providing information when they can do so. Commissioners of services should maintain ongoing contact with the provider, pupil, and parents with clear procedures for exchanging information, monitoring progress and providing pastoral support.
	The hon. Gentleman made some powerful points about reintegration into school, which are supported by the evidence from the CLIC Sargent report. There should be agreement on how to assess when the pupil is ready to return and the school should provide an appropriate package of support to assist their reintegration. There should be objectives and plans agreed with parents, providers and schools to ensure successful reintegration. The Government published advice on that last July and further advice on health needs early this year. We have taken action and if he believes that there is more to be done, I or my colleague the children’s Minister, the Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), will be happy to speak to him further.
	As the hon. Gentleman mentioned, the social aspects of reintegration are a huge issue for children and their families. While a child is absent, they should remain on the roll of their school and should be encouraged to feel part of the school. The schools should do everything possible to help the pupil keep in touch with their class, its work and other activities. Schools should also keep the pupil’s peers updated and help remind them that the pupil is still part of the school community.

Mark Tami: One point made in the CLIC Sargent review was that a school read out the child’s name in the register in every assembly. That was a powerful and important way of reminding the children that that child was still very much part of the school.

Elizabeth Truss: The hon. Gentleman makes a good point. The report contained some excellent examples of best practice. One that struck me was the friends who bought their fellow pupil an iPad so that they could keep in touch and had play dates so that the pupil felt that they were part of the school community while they were unable to attend. Unfortunately, the report also highlights other, less positive cases where there was bullying, perhaps caused by fear or lack of understanding. The Government believe that bullying is absolutely unacceptable and should never be tolerated. We have sent a strong message to schools on this, and we have shared advice and best practice. As part of the school’s approach to tackling bullying, it is also important that children with additional health needs are supported and not stigmatised or made to feel different. Schools need to ensure, through their behaviour and bullying policies and their re-integration plans, that these issues are considered.
	The hon. Gentleman mentioned the children and families Bill. The special educational needs measures in the Bill are specifically about special educational needs. They deal with a specific issue which, by its nature, does not include all children with medical needs. However, we are ensuring that SEN policy, policy on children with health needs in mainstream schools, and alternative provision policy are sufficiently joined up and work in a complementary way. We are also involving the sector, including parents and representative bodies such as CLIC Sargent, in our policy development and implementation. My officials are meeting CLIC Sargent later this month. We also want our guidance to be living documents which reflect developments, so that everybody who works in this area feels a sense of ownership and understands the important examples of best practice and case studies which were raised in the report and in other work.
	We are currently revising guidance for schools on supporting children with medical needs, including those with cancer. This complements the new guidance on
	ensuring a good education for children who cannot attend school because of health needs. We expect schools, employers, staff, parents and local health services to work together in the interests of the child, focusing on the outcome rather than the process.
	A pupil with cancer might fall behind in their education, for example if they are absent to receive treatment. Our advice to schools and local authorities includes ensuring better communication and information sharing to ensure that all involved in the pupil’s education are able to support the pupil to catch up. The hon. Gentleman mentioned English and maths. We are doing more general work to ensure that children who fall behind are able to catch up at the relevant point in their school career, so at the end of primary school a year 7 pupil who has not met the expected standards in literacy and numeracy will be given extra support, such as further tuition, through an additional premium of £500. This will provide valuable support to bring them up to speed in advance of secondary school. I hope that that will also help the students to whom the hon. Gentleman referred in his speech.
	A pupil who, earlier in their school career, needs additional help with reading will be identified through a year 1 phonics check and given extra support by their school to improve their reading skills. We want to make sure that pupils with cancer have the same opportunities as other pupils to take exams, that schools will support them in doing so, and that they are encouraged to continue at school if they are in the 16 to 18 age group that the hon. Gentleman mentioned.
	While students are not at school, there are important forms of provision, including hospital schools and home tuition. The hon. Gentleman mentioned that five hours were not enough and were not flexible enough. My understanding is that local authorities have a legal duty to arrange suitable education for a child who cannot attend school because of their health. It is up to the local authority to determine the best way to do that, but we expect local authorities to take into account advice offered by the hospital or a consultant when making decisions about that. If the child’s health allows, we expect that provision to be full-time. If that is not happening in practice, it needs to be followed up. That is an important part of the Government’s policy.
	I took the hon. Gentleman’s point that extra support should not necessarily stop when a child returns to school if the child needs such support. Again, this is about local authorities and health authorities working together.
	In conclusion, I thank the hon. Member for Alyn and Deeside for his excellent contribution to the debate, and I look forward to his participation in the upcoming Bill.
	Question put and agreed to.
	House adjourned.